Department of Neuroscience, Neurosurgery, Uppsala University, University Hospital , 751 85 Uppsala , Sweden.
Ups J Med Sci. 2014 Mar;119(1):38-43. doi: 10.3109/03009734.2013.849781. Epub 2013 Oct 23.
The management of patients with spontaneous subarachnoid haemorrhage (SAH) has changed, in part due to interventions now being extended to patients who are older and in a worse clinical condition. This study evaluates the effects of these changes on a complete 5-year patient material.
Demographic data and results from 615 patients with SAH admitted from 2007 to 2011 were put together. Aneurysms were found in 448 patients (72.8%). They were compared with the aneurysm group (n = 676) from a previously published series from our centre (2001-2006). Linear regression was used to determine variables predicting functional outcome in the whole aneurysm group (2001-2011).
Patients in the more recent aneurysm group were older, and they were in a worse clinical condition on admission. Regarding younger patients admitted in World Federation of Neurosurgical Societies SAH grading (WFNS) 3, there were fewer with a good outcome. In the whole aneurysm group 2001-2011, outcome was best predicted by age, clinical condition at admission, and the size of the bleeding, and not by treatment mode or localization of aneurysm.
It seems important for the outcome that aneurysms are treated early. The clinical course after that depends largely on the condition of the patient on admission rather than on aneurysm treatment method. This, together with the fact that older patients and those in worse condition are now being admitted, increases demands on neurointensive care. Further improvement in patient outcome depends on better understanding of acute brain injury mechanisms and improved neurointensive care as well as rehabilitation measures.
自发性蛛网膜下腔出血（SAH）患者的管理发生了变化，部分原因是现在将干预措施扩展到年龄更大、临床状况更差的患者。本研究评估了这些变化对完整的 5 年患者资料的影响。
将 2007 年至 2011 年收治的 615 例 SAH 患者的人口统计学数据和结果汇总在一起。在 448 例患者（72.8%）中发现了动脉瘤。他们与之前在我们中心发表的一系列系列（2001-2006）中的动脉瘤组（n = 676）进行了比较。线性回归用于确定整个动脉瘤组（2001-2011）的功能结果预测变量。
最近的动脉瘤组患者年龄较大，入院时临床状况较差。对于在世界神经外科学会联合会蛛网膜下腔出血分级（WFNS）3 级入院的年轻患者，预后良好的患者较少。在整个动脉瘤组（2001-2011 年）中，预后最佳的预测因素是年龄、入院时的临床状况和出血的大小，而不是治疗方式或动脉瘤的位置。
对于预后来说，动脉瘤的早期治疗似乎很重要。此后的临床过程在很大程度上取决于入院时患者的状况，而不是动脉瘤的治疗方法。这一点，再加上现在接受年龄更大、状况更差的患者，增加了对神经重症监护的需求。进一步改善患者预后取决于对急性脑损伤机制的更好理解以及神经重症监护以及康复措施的改善。
