120 例预后不良的颅内破裂动脉瘤性蛛网膜下腔出血患者 3 年后的临床状况。
Clinical condition of 120 patients alive at 3 years after poor-grade aneurysmal subarachnoid hemorrhage.
机构信息
Neurosurgery of NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland.
Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
出版信息
Acta Neurochir (Wien). 2021 Apr;163(4):1153-1166. doi: 10.1007/s00701-021-04725-2. Epub 2021 Feb 25.
BACKGROUND
To study the clinical condition of poor-grade aneurysmal subarachnoid hemorrhage (aSAH) patients alive at 3 years after neurointensive care.
METHODS
Of the 769 consecutive aSAH patients from a defined population (2005-2015), 269 (35%) were in poor condition on admission: 145 (54%) with H&H 4 and 124 (46%) with H&H 5. Their clinical lifelines were re-constructed from the Kuopio Intracranial Aneurysm Database and Finnish nationwide registries. Of the 269 patients, 155 (58%) were alive at 14 days, 125 (46%) at 12 months, and 120 (45%) at 3 years.
RESULTS
The 120 H&H 4-5 patients alive at 3 years form the final study population. On admission, 73% had H&H 4 but only 27% H&H 5, 59% intracerebral hematoma (ICH; median 22 cm), and 26% intraventricular blood clot (IVH). The outcome was favorable (mRS 0-1) in 45% (54 patients: ICH 44%; IVH clot 31%; shunt 46%), moderate (mRS 2-3) in 30% (36 patients: ICH 64%; IVH clot 19%; shunt 42%), and unfavorable (mRS 4-5) in 25% (30 patients: ICH 80%; IVH clot 23%; shunt 50%). A total of 46% carried a ventriculoperitoneal shunt. ICH volume was a significant predictor of mRS at 3 years.
CONCLUSIONS
Of poor-grade aSAH patients, 45% were alive at 3 years, even 27% of those extending to pain (H&H 5). Of the survivors, 75% were at least in moderate condition, while only 2.6% ended in hospice care. Consequently, we propose non-selected admission to neurointensive care (1) for a possibility of moderate outcome, and (2), in case of brain death, possibly improved organ donation rates.
背景
研究神经重症监护后 3 年存活的差级别的颅内动脉瘤性蛛网膜下腔出血（aSAH）患者的临床状况。
方法
在一个确定的人群（2005-2015 年）中，769 例连续的 aSAH 患者中有 269 例（35%）入院时病情较差：145 例（54%）为 H&H 4，124 例（46%）为 H&H 5。他们的临床生命线是从库奥皮奥颅内动脉瘤数据库和芬兰全国登记处重建的。在 269 例患者中，155 例（58%）在 14 天存活，125 例（46%）在 12 个月存活，120 例（45%）在 3 年存活。
结果
在 3 年时存活的 120 例 H&H 4-5 患者构成了最终的研究人群。入院时，73%为 H&H 4，但只有 27%为 H&H 5，59%为脑内血肿（ICH；中位数 22cm），26%为脑室内积血（IVH）。预后良好（mRS 0-1）者占 45%（54 例：ICH 44%；IVH 血块 31%；分流术 46%），预后中等（mRS 2-3）者占 30%（36 例：ICH 64%；IVH 血块 19%；分流术 42%），预后不良（mRS 4-5）者占 25%（30 例：ICH 80%；IVH 血块 23%；分流术 50%）。共有 46%的患者行脑室-腹腔分流术。ICH 体积是 3 年时 mRS 的显著预测因素。
结论
在差级别的 aSAH 患者中，45%的患者在 3 年后存活，即使是疼痛扩展到（H&H 5）的患者也有 27%存活。在幸存者中，75%至少处于中等状态，而只有 2.6%最终进入临终关怀。因此，我们建议非选择性地进入神经重症监护病房（1）有获得中等预后的可能，（2）在脑死亡的情况下，可能会提高器官捐献率。
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