Johansson M, Cesarini K G, Contant C F, Persson L, Enblad P
Department of Neuroscience, Section of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden.
Stroke. 2001 Dec 1;32(12):2845-949. doi: 10.1161/hs1201.099416.
The elderly constitute a significant and increasing proportion of the population. The aim of this investigation was to study time trends in clinical management and outcome in elderly patients with subarachnoid hemorrhage.
Two hundred eighty-one patients >/=65 years of age with aneurysmal subarachnoid hemorrhage who were accepted for treatment at the Uppsala University Hospital neurosurgery clinic during 1981 to 1998 were included. Hunt and Hess grades on admission, specific management components, and clinical outcomes were recorded. Three periods were compared: A, 1981 to 1986 (before neurointensive care); B, 1987 to 1992; and C, 1993 to 1998.
The volume of elderly patients (>/=65 years of age) increased with time, especially patients >/=70 years of age. Furthermore the proportion of patients with more severe clinical conditions increased. A greater proportion of patients had a favorable outcome (A, 45%; B, 61%; C, 58%) despite older ages and more severe neurological and clinical conditions. In period C, Hunt and Hess I to II patients had a favorable outcome in 85% of cases compared with 64% in period A. This was achieved without any increase in the number of severely disabled patients.
Elderly patients with subarachnoid hemorrhage can be treated successfully, and results are still improving. The introduction of neurointensive care may have contributed to the improved outcome without increasing the proportion of severely disabled patients. A defeatist attitude toward elderly patients with this otherwise devastating disease is not justified.
老年人在人口中所占比例显著且不断增加。本研究的目的是探讨老年蛛网膜下腔出血患者临床治疗及预后的时间趋势。
纳入1981年至1998年期间在乌普萨拉大学医院神经外科接受治疗的281例年龄≥65岁的动脉瘤性蛛网膜下腔出血患者。记录入院时的Hunt和Hess分级、具体治疗措施及临床结局。比较三个时间段：A组，1981年至1986年（神经重症监护之前）；B组，1987年至1992年；C组，1993年至1998年。
老年患者（≥65岁）数量随时间增加，尤其是≥70岁的患者。此外，临床病情较重的患者比例增加。尽管患者年龄更大、神经及临床病情更严重，但仍有更大比例的患者预后良好（A组，45%；B组，61%；C组，58%）。在C组，Hunt和Hess I至II级患者85%预后良好，而A组为64%。且重度残疾患者数量未增加。
老年蛛网膜下腔出血患者能够得到成功治疗，且结果仍在改善。神经重症监护的引入可能有助于改善预后，同时不增加重度残疾患者的比例。对于患有这种原本具有毁灭性疾病的老年患者持悲观态度是没有道理的。
