4. Discussion
hypoxic damage, rebleeding, aSAH, Rebleeding, cerebral aneurysms, rupture, neurological deficits, nosocomial infection, aneurysmal subarachnoid hemorrhage, DCI
DELAYED CEREBRAL ISCHEMIA, NEUROLOGICAL COMPLICATION, CLINICAL SYNDROME, DISEASE, DCI, CEREBRAL VASOSPASM, NOSOCOMIAL INFECTION, CEREBRAL ANEURYSMS, EVENTS, COMPLICATIONS
aSAH is a clinical syndrome caused by the rupture of a blood vessel at the base of the skull or on the surface of the brain and the direct flow of blood into the subarachnoid space [Delayed cerebral ischemia is a major factor in the poor prognosis of aneurysmal subarachnoid hemorrhage, and DCI has irreversible and serious consequences once it occurs. Therefore, early prediction and prevention are important [In addition to exploring the specific mechanisms of DCI, various scholars have focused their research on aSAH and attempted to find more precise therapeutic targets and promising therapies to improve the prognosis of patients with aSAH through trends in certain pathophysiological processes or biomarkers [Biological markers, although highly sensitive, require multiple samplings of patients in a staged fashion due to the dynamics of interactions between systems in the body, and the corresponding clinical scores have shown better affordability compared to biological indicators. Different types of prognostic scores have been applied to patients with aSAH, including the GCS score, WFNS, and Fisher score, among others, all of which have been correlated with the severity and prognosis of aSAH [In this study, we used DCI as an entry point to examine risk factors that may be associated with it and included risk factors that may be associated with it outside of the quantitative neurological indicators in the modeling. Few studies have predictive models for aneurysmal subarachnoid hemorrhage, except for predictive risk in clinical fluid samples. In this study, the probability of DCI in this patient was obtained by statistical modeling and quantitative assessment of each risk factor in the model using a simple and easy-to-use column line graph. This model can help clinicians develop the most beneficial treatment plan for patients in early decision making, consistent with the principle of individualized treatment.Our study ultimately incorporated five factors (EVD, rebleeding, duration of mechanical ventilation, days of hospitalization, and treatment modality) to construct the final predictive column line graph and to elucidate the validity of the model from three perspectives: mechanism, theoretical basis, and statistical validation.An EVD can be combined with postoperative monitoring results to promptly adjust drainage to ensure the drainage effect and achieve an effective reduction in intracranial pressure. It can slowly release bloody cerebrospinal fluid and reduce stimulation damage to cerebral vessels and brain tissue, improve blood supply to brain tissue, reduce ischemic and hypoxic damage to brain tissue, facilitate inhibition of progressive progression of neurological deficits, and improve prognosis [To our surprise, the risk score was higher for patients who underwent external ventricular drain (EVD) (15 points) than for those who did not (0 points), and we reasoned that the prevention of DCI depends on maintaining adequate cerebrovascular volume and that EVD plays a negative regulatory role in maintaining blood volume, which is worthy of a follow-up study.Rebleeding and DCI after aSAH have been reported to be highly morbid and potentially fatal events that appear to have an independent negative impact on overall functional outcomes. However, early rebleeding did not significantly affect the risk of delayed ischemic complications, and rebleeding after aSAH was associated with multiple somatic and neurological complications, leading to increased morbidity and mortality, but not with changes in the incidence or timing of DCI [As patients receive mechanical ventilation for longer periods, the risk of nosocomial infection increases significantly; therefore, the DCI risk score increases in steps [Endovascular coiling for the treatment of cerebral aneurysms can achieve better clinical outcomes than open clipping and has obvious minimally invasive advantages. However, the current cost of vascular intervention is relatively high and may be the procedure of choice for this disease when economic conditions allow it [In addition to previous studies and the theoretical basis, the risk model developed in this study, from a statistical perspective, is notable in terms of differentiation, calibration, and clinical decision making, and the model has both theoretical and practical values in providing individualized treatment options for patients with aSAH who require mechanical ventilation.The limitations of this study are as follows. The included patient population is a single-center group, which is not well represented, and the sample size and case sources are expected to be further expanded in the future. In addition, the study did not include information on patients' tests, such as routine blood chemistry, and it would have been better to include quantitative indicators of the course of specific changes in vital signs. However, the results of this study provide a clear direction for a reasonable prediction of the risk of serious complications, such as DCI in patients requiring intensive care and mechanical ventilation, which would help clinicians better identify the population at risk and help them make appropriate clinical decisions. For example, if a patient is determined to be at higher risk of developing DCI as per nomogram, early investigation measures, such as transcranial Doppler ultrasound or cerebral perfusion imaging to determine if a patient has developed cerebral vasospasm, and the use of nimodipine to prevent and maintain normal cerebrovascular volumes are essential, while in patients at low risk, overmedication can be avoided.