Sun Jie, Wang Zeyi, Su Ping, Liu Jun, Li Junyan, Ma Gang, Cen Jianchang, Chang Qian, Liu Xinghai, Zhao Nan
Department of Neurosurgery, Kunming First People's Hospital, Kunming 650000, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2020 Sep 30;40(9):1353-1358. doi: 10.12122/j.issn.1673-4254.2020.09.20.
To investigate the clinical outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) after surgeries in Yunnan Province.
We retrospectively analyzed the demographic features, vascular risk factors, severity at admission, and aneurysm locations in 85 patients with aSAH receiving surgical interventions in Yunnan Province. All the patients were treated by aneurysm clipping or coiling and followed up for clinical outcomes and recovery of daily activities evaluated by modified Rankin Scale (mRS) and Activities of Daily Living (ADL) scale, respectively.
Thirty-four of the patients (40.0%) underwent aneurysm clipping and 51 (60.0%) underwent aneurysm coiling. During a median follow- up period of 66.23 months (IOR, 12.03 months), 84.7% of the patients had low mRS scores, and 78.8% lived independently. The WFNS grade at admission was significantly correlated with the follow-up mRS scores (95%: 1.48-19.09, =0.011) and ADL (95%: 2.55-28.77, < 0.001). Multivariate analysis showed that age (95%: 1.02-1.23, =0.017; 95%: 1.00-1.15, =0.038) and a high WFNS grade at admission (95%: 2.19-141.48, =0.007; 95%: 2.84-82.61, =0.002) were independent predictors of both mRS and ADL scores at follow-up. There was no significant difference in clinical outcomes or the length of hospital stay between the two treatment strategies ( > 0.05), but the cost of hospitalization was significantly higher in coiling group than in the clipping group ( < 0.001).
Both aging and a high WFNS grade at admission are associated with a poor prognosis of aSAH, for which aneurysm clipping and coiling have similar long- term outcomes, but for patients with a high WFNS score, aneurysm clipping is favored over coiling in terms of health economics.
探讨云南省动脉瘤性蛛网膜下腔出血（aSAH）患者手术后的临床结局。
我们回顾性分析了云南省85例接受手术干预的aSAH患者的人口统计学特征、血管危险因素、入院时的严重程度及动脉瘤位置。所有患者均接受动脉瘤夹闭或栓塞治疗，并分别采用改良Rankin量表（mRS）和日常生活活动能力（ADL）量表对临床结局和日常生活活动恢复情况进行随访。
34例患者（40.0%）接受了动脉瘤夹闭术，51例（60.0%）接受了动脉瘤栓塞术。在中位随访期66.23个月（四分位间距，12.03个月）内，84.7%的患者mRS评分较低，78.8%的患者能够独立生活。入院时的世界神经外科联盟（WFNS）分级与随访时的mRS评分（95%置信区间：1.48 - 19.09，P = 0.011）及ADL评分（95%置信区间：2.55 - 28.77，P < 0.001）显著相关。多因素分析显示，年龄（95%置信区间：1.02 - 1.23，P = 0.017；95%置信区间：1.00 - 1.15，P = 0.038）和入院时较高的WFNS分级（95%置信区间：2.19 - 141.48，P = 0.007；95%置信区间：2.84 - 82.61，P = 0.002）是随访时mRS和ADL评分的独立预测因素。两种治疗策略的临床结局或住院时间无显著差异（P > 0.05），但栓塞组的住院费用显著高于夹闭组（P < 0.001）。
年龄增长和入院时较高的WFNS分级均与aSAH的不良预后相关，动脉瘤夹闭和栓塞的长期结局相似，但对于WFNS评分较高的患者，从卫生经济学角度考虑，动脉瘤夹闭优于栓塞。
