McGinity Michael J, Michalek Joel E, Rodriguez Jesse S, Floyd John R
a Department of Neurosurgery , University of Texas Health Science Center at San Antonio , San Antonio , TX , USA.
b Department of Epidemiology and Biostatistics , University of Texas Health Science Center at San Antonio , San Antonio , TX , USA.
Br J Neurosurg. 2017 Dec;31(6):714-717. doi: 10.1080/02688697.2017.1341041. Epub 2017 Jun 15.
Elderly patients presenting with an acute subdural hematoma (aSDH) have historically had unfavorable outcomes.
We retrospectively reviewed patient records from 2005 through 2015 that were ≥80 years of age and underwent surgical evacuation of aSDH.
Thirty-four patients met inclusion criteria, with a mean age of 84 years (range 80-91). Glascow Outcome Scale (GOS) of 4-5 was deemed a good outcome and a GOS 1-3 was deemed to be a poor outcome. Six patients had good outcome at last follow up and 27 patients had poor outcome. Patients with a higher presenting Glascow Coma Scale (GCS) trended towards better outcome [(good: mean 13.1, median 14.5, IQR 12.5-15) vs. (poor: mean 9.6, median 10, IQR 6-14) p = 0.06]. Patients with a higher in-hospital post-operative GCS score had significantly better overall outcome than patients who left the hospital with a lower GCS score [(good: mean 14.5, median 14.5, IQR 14-15) vs. (poor: mean 8.4, median 9, IQR 4-11) p = 0.001]. Patients with a good outcome had a median aSDH thickness of 17mm (IQR 12.75-19.75) while patients with a poor outcome had a median thickness of 20mm (IQR 16-24.5); p = 0.17. In addition, patients with a good outcome had a median midline shift of 10mm (IQR 6-12.5), while patients with a poor outcome had a median midline shift of 14mm (IQR 10-20); p = 0.07.
The prognosis for elderly patients with large aSDH remains poor, but a subset of patients can benefit from surgical intervention.
急性硬膜下血肿（aSDH）老年患者的预后历来不佳。
我们回顾性分析了2005年至2015年间年龄≥80岁且接受aSDH手术清除的患者记录。
34例患者符合纳入标准，平均年龄84岁（范围80 - 91岁）。格拉斯哥预后量表（GOS）评分为4 - 5分被视为良好预后，GOS评分为1 - 3分被视为不良预后。6例患者在最后一次随访时预后良好，27例患者预后不良。入院时格拉斯哥昏迷量表（GCS）评分较高的患者预后有改善趋势[（良好：平均13.1，中位数14.5，四分位间距12.5 - 15）vs.（不良：平均9.6，中位数10，四分位间距6 - 14）p = 0.06]。术后住院期间GCS评分较高的患者总体预后明显优于出院时GCS评分较低的患者[（良好：平均14.5，中位数14.5，四分位间距14 - 15）vs.（不良：平均8.4，中位数9，四分位间距4 - 11）p = 0.001]。预后良好的患者aSDH厚度中位数为17mm（四分位间距12.75 - 19.75），而预后不良的患者厚度中位数为20mm（四分位间距16 - 24.5）；p = 0.17。此外，预后良好的患者中线移位中位数为10mm（四分位间距6 - 12.5），而预后不良的患者中线移位中位数为14mm（四分位间距10 - 20）；p = 0.07。
老年aSDH患者的预后仍然很差，但一部分患者可从手术干预中获益。
