Department of Radiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Crit Care Med. 2011 Dec;39(12):2722-7. doi: 10.1097/CCM.0b013e3182282a70.
Only a small percentage of World Federation of Neurologic Surgeons grade V aneurysmal subarachnoid hemorrhage patients have a favorable outcome. The influence of clinical parameters on outcome was assessed.
Retrospective evaluation of consecutive patients admitted from 2000-2007 with grade V subarachnoid hemorrhage at two institutions by evaluating, over time, the motor value of the Glasgow Coma Scale, effects of external ventricular drainage and rebleeding on outcome. Six-month outcome was assessed with the extended Glasgow Outcome Scale; favorable outcome was defined as good recovery or moderately disabled.
Of 126 patients, 28 had absent brainstem reflexes, without improvement after external ventricular drainage. Rebleeding occurred in 26 patients, resulting in treatment withdrawal in 14. Only one patient had a favorable outcome after rebleeding. Of the 84 remaining patients, 61 improved at day 2 after subarachnoid hemorrhage to Glasgow Coma Scale motor value ≥4; 24 of these (39%) had a favorable outcome. All 23 patients with a Glasgow Coma Scale motor value ≤3 had an unfavorable outcome or died. Patients younger than 65 yrs of age had a better outcome (p < .03). Hydrocephalus was present in 71 of 84 patients. Favorable outcome was similar for patients with a positive external ventricular drainage response (8 of 28) as compared to no response to external ventricular drainage (12 of 43).
The high rebleeding rate and subsequent poor outcome in World Federation of Neurologic Surgeons grade V patients warrants early treatment to secure the ruptured aneurysm. Favorable outcome was seen in 39% of patients with a Glasgow Coma Scale motor value ≥4 at day 2. In this study, patients with Glasgow Coma Scale motor value ≤3 at day 2 all had a very poor prognosis.
只有一小部分世界神经外科学会（WFNS）五级破裂性蛛网膜下腔出血患者的预后良好。本研究评估了临床参数对预后的影响。
通过评估两家机构 2000 年至 2007 年连续收治的 WFNS 五级蛛网膜下腔出血患者的格拉斯哥昏迷量表（GCS）运动值，以及外引流和再出血对预后的影响，对患者进行回顾性评估。采用格拉斯哥预后量表（GOS）扩展版评估 6 个月的预后；良好预后定义为恢复良好或中度残疾。
126 例患者中，28 例患者存在脑干反射消失，外引流后无改善。26 例患者发生再出血，14 例患者因再出血而停止治疗。再出血后仅有 1 例患者预后良好。84 例其余患者中，84 例患者中有 61 例在蛛网膜下腔出血后第 2 天 GCS 运动值≥4；其中 24 例（39%）预后良好。GCS 运动值≤3 的所有 23 例患者预后不良或死亡。年龄<65 岁的患者预后较好（p<0.03）。71 例患者存在脑积水。外引流反应阳性的 28 例患者和外引流反应阴性的 43 例患者的预后良好率相似。
WFNS 五级患者的再出血率高，预后不良，需要早期治疗以确保破裂的动脉瘤得到治疗。在本研究中，GCS 运动值在第 2 天≥4 的患者中有 39%预后良好。在这项研究中，第 2 天 GCS 运动值≤3 的患者预后均非常差。
