Department of Neuropsychiatry and Psychosomatic Medicine, Rikshospitalet, Oslo, Norway.
Neurosurgery. 2010 Mar;66(3):475-84; discussion 484-5. doi: 10.1227/01.NEU.0000365364.87303.AC.
The objective of this study was to determine cognitive functioning and health-related quality of life 1 year after aneurysmal subarachnoid hemorrhage in preoperative comatose patients (Hunt and Hess Grade V patients).
Patients who were comatose at hospital arrival and thereafter were investigated for 1 year using a comprehensive neuropsychological test battery and 2 HRQOL questionnaires.
Thirty-five of 70 patients survived the bleed, and 26 underwent neuropsychological testing. Two distinct patient groups emerged, one (n = 14) with good cognitive function, having mild deficits only, and the other (n = 12) with poor cognitive and poor motor function. Patients performing poorly were older (P = .04), had fewer years of education (P = .005) and larger preoperative ventricular scores, and were more often shunted (P = .02). There were also differences between the 2 groups in the Glasgow Outcome Scale (P = .001), the modified Rankin Scale (P = .001), and employment status. HRQOL was more reduced in patients with poor cognitive function.
A high fraction of survivors among preoperative comatose aneurysmal SAH patients (Hunt and Hess grade V) recover to good physical and cognitive function, enabling them to live a normal life.
本研究旨在确定术前昏迷（Hunt 和 Hess 分级 V 级）的动脉瘤性蛛网膜下腔出血患者 1 年后的认知功能和健康相关生活质量。
对入院后昏迷且此后昏迷的患者进行了为期 1 年的综合神经心理学测试和 2 项 HRQOL 问卷调查。
70 例患者中有 35 例存活出血，26 例接受了神经心理学测试。出现了两个明显不同的患者群体，一个群体（n=14）认知功能良好，仅有轻度缺陷，另一个群体（n=12）认知和运动功能均较差。认知功能差的患者年龄较大（P=0.04），受教育年限较少（P=0.005），术前脑室评分较高，分流更多（P=0.02）。两组在格拉斯哥预后量表（P=0.001）、改良 Rankin 量表（P=0.001）和就业状况方面也存在差异。认知功能差的患者 HRQOL 降低更为明显。
术前昏迷的动脉瘤性蛛网膜下腔出血患者（Hunt 和 Hess 分级 V 级）中有相当一部分患者恢复到良好的身体和认知功能，使他们能够过上正常的生活。
