Barth Martin, Thomé Claudius, Schmiedek Peter, Weiss Christel, Kasuya Hidetoshi, Vajkoczy Peter
Department of Neurosurgery, University Hospital, Mannheim Faculty for Clinical Medicine, Karl-Ruprecht-University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
J Neurosurg. 2009 May;110(5):955-60. doi: 10.3171/2008.2.17670.
The use of nicardipine prolonged-release implants (NPRIs) is associated with a significant improvement in the therapy of patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) regarding the occurrence and severity of cerebral vasospasm, new infarcts, and functional outcome (FO). Because quality of life (QOL) measurements more reliably seem to describe the patient's true condition, the present study was conducted to assess FO and QOL 1 year after aneurysm rupture in patients with and without NPRIs.
From the initial series of 32 patients, 18 were assessed 1 year after aSAH (7 of the control and 11 of the NPRI group). The patients underwent neurological investigation, a structured interview followed by a measurement of QOL (Mini-Mental State Examination [MMSE]; 36-Item Short Form Health Survey [SF-36]; and the Hamilton Depression Rating Scale). There were no intergroup differences in the patient characteristics (that is, localization of aneurysm, initial Hunt and Hess grade, or age).
In addition to the previously reported improvement of the National Institutes of Health Stroke Scale and modified Rankin Scale scores, the NPRI group's Karnofsky Performance Scale and the MMSE scores were markedly to significantly improved (p < 0.05 [Karnofsky Performance Scale] and p = 0.053 [MMSE]). In contrast, anxiety, oblivion, and mild symptoms of depression were equally present in both study groups (p = 0.607 [anxiety]; p = 0.732 [oblivion]; and p = 0.509 [Hamilton Depression Rating Scale]). Furthermore, no intergroup differences were observed in any of the SF-36 domains. The scores in the SF-36 domains of Role-Physical, Vitality, and Role-Emotional were significantly reduced in the NRPI group compared with those observed in an age-matched control population (p < 0.001 [Role-Physical]; p = 0.001 [vitality]; and p = 0.01 [Role-Emotional]). Considering consequent costs, no difference was detectable regarding the duration of in- and outpatient rehabilitation (p = 0.135 and 0.171, respectively) or the Prolo score (p = 0.094).
Despite FO improvement in terms of a lower incidence of cerebral vasospasm, new infarcts, morbidity in the treatment of aSAH in patients with NPRIs, a patient's QOL seems to be related to the severity of the aSAH itself.
使用尼卡地平缓释植入物（NPRIs）在治疗动脉瘤性蛛网膜下腔出血（aSAH）患者时，在脑血管痉挛的发生和严重程度、新发梗死以及功能结局（FO）方面有显著改善。由于生活质量（QOL）测量似乎能更可靠地描述患者的真实状况，因此本研究旨在评估有无NPRIs的aSAH患者动脉瘤破裂1年后的功能结局和生活质量。
在最初的32例患者系列中，18例在aSAH后1年接受评估（对照组7例，NPRI组11例）。患者接受了神经学检查、结构化访谈，随后进行了生活质量测量（简易精神状态检查表[MMSE]；36项简短健康调查问卷[SF - 36]；以及汉密尔顿抑郁量表）。患者特征（即动脉瘤位置、初始Hunt和Hess分级或年龄）在组间无差异。
除了先前报道的美国国立卫生研究院卒中量表和改良Rankin量表评分的改善外，NPRI组的卡氏功能状态量表和MMSE评分有显著至非常显著的改善（p < 0.05[卡氏功能状态量表]和p = 0.053[MMSE]）。相比之下，焦虑、遗忘和轻度抑郁症状在两个研究组中均同样存在（p = 0.607[焦虑]；p = 0.732[遗忘]；p = 0.509[汉密尔顿抑郁量表]）。此外，SF - 36各领域在组间均未观察到差异。与年龄匹配的对照人群相比，NPRI组在SF - 36的角色 - 身体、活力和角色 - 情感领域的得分显著降低（p < 0.001[角色 - 身体]；p = 0.001[活力]；p = 0.01[角色 - 情感]）。考虑到后续成本，在住院和门诊康复时间（分别为p = 0.135和0.171）或普罗洛评分（p = 0.09）方面未发现差异。
尽管在使用NPRIs的aSAH患者中，脑血管痉挛、新发梗死的发生率降低以及治疗中的发病率方面功能结局有所改善，但患者的生活质量似乎与aSAH本身的严重程度相关。
