van Middelaar Tessa, Richard Edo, van der Worp H Bart, van den Munckhof Pepijn, Nieuwkerk Pythia T, Visser Marieke C, Stam Jan, Nederkoorn Paul J
Department of Neurology, Academic Medical Center (AMC) Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands.
BMC Neurol. 2015 Aug 28;15:156. doi: 10.1186/s12883-015-0407-0.
In patients with a space-occupying middle cerebral artery (MCA) infarct surgical decompression reduces the risk of death, but increases the chance of survival with severe disability. We assessed quality of life (QoL), symptoms of depression, and caregiver burden at long-term follow-up.
Patients treated in two academic centres between 2007 and 2012 were included. Follow-up was at least six months. Patients and caregivers were interviewed separately. QoL was assessed with a visual analogue scale and the 36-item Short-Form health survey (SF-36); depression with the Hospital Anxiety and Depression Scale; and caregiver burden with the Caregiver Strain Index.
Twenty five patients were enrolled, of whom seven had an infarct in the dominant hemisphere. After a median follow-up of 26 months (IQR 11-46) the median SF-36 mental component score was 54.4 (IQR 45-60), indicating a mental QoL comparable to that in the general population. The median SF-36 physical component score was 32.7 (IQR 22-38), indicating a worse physical QoL. Dominance of the hemisphere did not influence QoL. 79 % of patients and 65 % of caregivers would, in retrospect, again choose for surgery. 26 % of patients had signs of depression and 64 % of caregivers were substantially burdened in their daily life.
Mental QoL after surgical decompression for space-occupying MCA infarct is comparable to that in the general population, whereas physical QoL is worse. Dominance of the hemisphere did not influence QoL. The majority of caregivers experience substantial burden. Most patients and caregivers stand by their decision for hemicraniectomy.
对于大脑中动脉（MCA）梗死伴占位性病变的患者，手术减压可降低死亡风险，但会增加严重残疾存活的几率。我们评估了长期随访时的生活质量（QoL）、抑郁症状和照顾者负担。
纳入2007年至2012年在两个学术中心接受治疗的患者。随访至少6个月。分别对患者和照顾者进行访谈。采用视觉模拟量表和36项简明健康调查（SF - 36）评估生活质量；采用医院焦虑抑郁量表评估抑郁；采用照顾者压力指数评估照顾者负担。
共纳入25例患者，其中7例梗死位于优势半球。中位随访26个月（四分位间距11 - 46）后，SF - 36精神健康分量表的中位得分是54.4（四分位间距45 - 60），表明精神生活质量与普通人群相当。SF - 36生理健康分量表的中位得分是32.7（四分位间距22 - 38），表明生理生活质量较差。半球优势并不影响生活质量。回顾性分析显示，79%的患者和65%的照顾者会再次选择手术。26%的患者有抑郁迹象，64%的照顾者在日常生活中负担沉重。
MCA梗死伴占位性病变手术减压后的精神生活质量与普通人群相当，而生理生活质量较差。半球优势并不影响生活质量。大多数照顾者负担沉重。大多数患者和照顾者坚持他们进行去骨瓣减压术的决定。
