Asano Shuichiro, Hara Tetsuo, Haisa Toshihiko, Okamoto Koichiro, Kato Takahiro, Ohno Hiroyasu, Hasuo Kanehiro, Kondo Tatsuya
Department of Neurosurgery, International Medical Center of Japan, Tokyo, Japan.
Clin Neurol Neurosurg. 2007 Dec;109(10):853-7. doi: 10.1016/j.clineuro.2007.08.001. Epub 2007 Sep 14.
In the developed countries, elderly population is rapidly increasing, but outcomes of elderly patients with subarachnoid hemorrhage (SAH) remain unclear.
We retrospectively reviewed the medical records of non-traumatic SAH patients aged 80 years or older, who were hospitalized in a single center between 2000 and 2005.
There were 24 patients (80-92 years old and 83% female), representing 8.8% of all non-traumatic SAHs (n=272). Of those, six patients received an intervention (five clipping and one endovascular coiling) and the remaining 18 patients were managed conservatively. The patients who received an intervention were younger and had a better consciousness at presentation. Early mortality rate within 30 days after SAH was higher in the conservative group (61% [11/18] and 17% [1/6], p=0.155). At 6 months, mortality rate was significantly higher in the conservative group (83% [15/18] and 33% [2/6], p=0.038), and independence rate was higher in the intervention group (33% [2/6] and 0% [0/18], p=0.054). Logistic regression analysis showed that age and degree of consciousness on admission were significant predictor of outcome in 4 weeks, and that receiving intervention was significant predictor of outcome in 6 months.
In elderly SAH patients with good clinical condition at presentation, an active intervention may improve the outcome.
在发达国家,老年人口正在迅速增加,但老年蛛网膜下腔出血(SAH)患者的治疗结果仍不明确。
我们回顾性分析了2000年至2005年期间在单一中心住院的80岁及以上非创伤性SAH患者的病历。
共有24例患者(年龄80 - 92岁,83%为女性),占所有非创伤性SAH患者(n = 272)的8.8%。其中,6例患者接受了干预(5例夹闭术和1例血管内栓塞术),其余18例患者接受保守治疗。接受干预的患者年龄较轻,入院时意识状态较好。SAH后30天内保守治疗组的早期死亡率较高(61% [11/18]和17% [1/6],p = 0.155)。6个月时,保守治疗组的死亡率显著较高(83% [15/18]和33% [2/6],p = 0.038),干预组的独立率较高(33% [2/6]和0% [0/18],p = 0.054)。逻辑回归分析显示,年龄和入院时的意识程度是4周时预后的显著预测因素,而接受干预是6个月时预后的显著预测因素。
对于入院时临床状况良好的老年SAH患者,积极干预可能改善预后。