[PREDICTORS OF RE-BLEEDING IN THE ACUTE PERIOD OF RUPTURE OF CEREBRAL ARTERIAL ANEURYSMS].

to identify predictors of early re-bleeding from AA of the brain and to determine their prognostic value. We carried out a retrospective analysis of 394 case histories of patients aged 18 to 85 years who were treated at the ME "Dnepropetrovsk Regional Hospital named after I. I.I. Mechnikov" for a ruptured AA brain in the period from 2013 to 2018. There were 203 men and 191 women, оf these 62 died without surgery. The rest underwent microsurgical clipping of the aneurysm at various times. During the analysis, attention was paid to the following indicators: age, sex, severity of the condition according to the Hunt-Hess scale (HH) and the level of impairment of consciousness according to the Glasgow Coma Scale (GCS) on the day of admission and on the day of surgery, the mean arterial pressure dynamics, neuropsychological status of the patient, the presence of concomitant pathology, the severity of subarachnoid hemorrhage (SAH) according to Fisher scale, the presence and volume of the parenchymal component of the hemorrhage, the severity and prevalence of angiospasm (AS), anatomical features of the aneurysmal sac according to spiral computed tomography (SCT) and cerebral angiography (CAG). Out of 394 patients with AA rupture, re-bleeding was observed in 50 patients (12.7%). Among 62 patients with fatal outcome who were not operated due to various reasons (16.1%) in 10 cases there was re-bleeding that was the cause of death. From 40 patients with re-bleeding were operated at various times with a postoperative mortality rate of 22.5%. Within 1 week, re-bleeding developed in 21 patients (42%) and in 16 patients (32%) during the second week. Patients with a decrease in criticism of their condition had repeated bleeding twice as often, in patients with psychomotor agitation - three times more often (21.4%). Most often re-breeding (25%) were observed in patients with poorly corrected blood pressure. The frequency of re-bleeding depending on the severity of angiospasm and localization of aneurysms was statistically insignificant in our study. Statistically reliable predictors of re-bleeding are the severity of the patient's condition on the Hunt-Hess scale of grade 3-4 (p = 0.003) and the level of impairment of consciousness on the GCS scale of 9-12 points (p = 0.026), and uncorrected arterial hypertension in patients with mean blood pressure 130- 145 mm Hg led to re-bleeding most often - in 25% of cases (p=0.001). The patient's psychomotor agitation led to re-bleeding in 21.4% of patients (p=0.027), and the presence of a diverticulum in the aneurysm wall in 17.6% of cases. Most often, re-bleeding occurred in patients without AS, or with grade 3 AS (23% and 16.3%, respectively), but these data were not statistically reliable. In this study, re-bleeding was noted in patients with ruptured arterial aneurysms of the brain in 12.7% of cases, which is significantly lower than indicated in previous studies and literature data.