Green Theresa L, Newcommon Nancy, Demchuk Andrew
University of Calgary, Faculty of Nursing.
Can J Neurosci Nurs. 2010;32(2):24-33.
The aim of this narrative review of the literature was to examine the current state of knowledge regarding the impact of aggressive surgical interventions for severe stroke on patient and caregiver quality of life and caregiver outcomes.
Decompressive hemicraniectomy (DHC) is a surgical therapeutic option for treatment of massive middle cerebral artery infarction (MCA), lobar intracerebral hemorrhage (ICH), and severe aneurysmal subarachnoid hemorrhage (aSAH). Decompressive hemicraniectomy has been shown to be effective in reducing mortality in these three life-threatening conditions. Significant functional impairment is an experience common to many severe stroke survivors worldwide and close relatives experience decision-making difficulty when confronted with making life or death choices related to surgical intervention for severe stroke.
Academic Search Premier, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, and PsychInfo.
A narrative review methodology was utilized in this review of the literature related to long-term outcomes following decompressive hemicraniectomy for stroke. The key words decompressive hemicraniectomy, severe stroke, middle cerebral artery stroke, subarachnoid hemorrhage, lobar ICH, intracerebral hemorrhage, quality of life, and caregivers, literature review were combined to search the databases.
Good functional outcomes following DHC for life-threatening stroke have been shown to be associated with younger age and few co-morbid conditions. It was also apparent that quality of life was reduced for many stroke survivors, although not assessed routinely in studies. Caregiver burden has not been systematically studied in this population.
Most patients and caregivers in the studies reviewed agreed with the original decision to undergo DHC and would make the same decision again. However, little is known about quality of life for both patients and caregivers and caregiver burden over the long-term post-surgery. Further research is needed to generate information and interventions for the management of ongoing patient and carer recovery following DHC for severe stroke.
本叙述性文献综述的目的是研究关于积极手术干预对重症中风患者及其照顾者生活质量以及照顾者结局影响的现有知识状况。
减压性颅骨切除术（DHC）是治疗大面积大脑中动脉梗死（MCA）、脑叶脑出血（ICH）和严重动脉瘤性蛛网膜下腔出血（aSAH）的一种手术治疗选择。减压性颅骨切除术已被证明在降低这三种危及生命疾病的死亡率方面有效。严重功能障碍是全球许多重症中风幸存者的共同经历，当面临与重症中风手术干预相关的生死抉择时，近亲会经历决策困难。
学术搜索高级版、护理及相关健康文献累积索引（CINAHL）、医学索引数据库（Medline）和心理学文摘数据库（PsychInfo）。
本关于中风减压性颅骨切除术后长期结局的文献综述采用叙述性综述方法。将关键词“减压性颅骨切除术”、“重症中风”、“大脑中动脉中风”、“蛛网膜下腔出血”、“脑叶脑出血”、“脑出血”、“生活质量”、“照顾者”和“文献综述”组合起来搜索数据库。
对于危及生命的中风，DHC术后良好的功能结局已被证明与较年轻的年龄和较少的合并症有关。同样明显的是，许多中风幸存者的生活质量下降，尽管在研究中未进行常规评估。在这一人群中尚未对照顾者负担进行系统研究。
在所综述研究中的大多数患者和照顾者都同意最初进行DHC的决定，并且会再次做出相同的决定。然而，对于患者和照顾者的生活质量以及术后长期的照顾者负担知之甚少。需要进一步研究以生成信息并制定干预措施，用于管理重症中风DHC术后患者和照顾者的持续康复。
