Effect of postoperative multiple organ failure on early mortality after the surgical treatment of hemorrhagic strokes

Abstract

Introduction. Intracranial hemorrhages make from 10 to 15% of cerebrovascular accidents (CVA). Lethality at conservative treatment in first 30 days reaches 35%. Today surgical methods of treatment are used, that often are accompanied by multiple organ dysfunction syndrome (MODS). These data were not described in literature.Materials and methods. 224 patients after hemorrhagic stroke surgical treatment were examined, 119 of them are alive, 105 — died. In the early postoperative period SOFA scale was used for MODS severity estimation, and R. Bone criteria — for SIRS.Results. Even at short-time deterioration of the patients’ state (3 points on SOFA scale and more) the lethality increased. At the dead indicators of heart rate (HR), respiration rate (RR), body’s temperature corresponded to SIRS, indicators of Glasgow Coma Scale (GCS), PaO2/FiO2, average blood pressure were in a stage of the expressed insufficiency. At the survived the above-mentioned SIRS indicators were normal, MODS indicators — in a stage of dysfunction. The difference between MODS and SIRS indicators at dead and survived patients increased significantly in the early postoperative period. Lethality predictors that were revealed 5–10 times more often at unfavorable prognosis and were reliable (P<0.001) were considered as cerebral (GCS 9 points and less), respiratory (PaO2/FiO2 200 and less), heart (average BP less than 70 mm Hg, dopamine infusion more than 5 mcg´kg-1´h-1), renal (creatine 300 mg/L and more) insufficiency and score on SOFA scale more than 10. A lethality was significantly influenced by SIRS indicators (HR, RR, body’s temperature).