Schmitz Jens, Kashefiolasl Sepide, Brawanski Nina, Dinc Nazife, Gessler Florian, Senft Christian, Tritt Stephanie, Seifert Volker, Konczalla Jürgen
Department of Neurosurgery, Goethe-University Hospital, 60528 Frankfurt am Main, Germany.
BG Klinikum Duisburg gGmbH, 47249 Duisburg, Germany.
Diseases. 2021 Oct 7;9(4):69. doi: 10.3390/diseases9040069.
In about 25% of patients with spontaneous subarachnoid hemorrhage (SAH), a bleeding source cannot be identified during radiological diagnostics. Generally, the outcome of perimesencephalic or prepontine (PM) SAH is known to be significantly better than after non-PM SAH. Data about long-term follow-up concerning physical and mental health are scarce, so this study is reports on long-term results. We measured the influence of PM SAH on a quality-of-life modified Rankin (mRs) scale after six months. For long-term follow-up, a SF-36 questionnaire was used. Questionnaires were sent out between 18 and 168 months after ictus. In 37 patients, a long-term follow-up was available (up to 14 years after SAH). Data detected with the SF-36 questionnaire are compared to reference applicability to the standard population. In total, 37 patients were included for further analysis and divided in 2 subgroups; 13 patients (35%) received subsequent rehabilitation after clinical stay and 24 (65%) did not. In the short-term outcome, a significant improvement from discharge until follow-up was identified in patients with subsequent rehabilitation, but not in the matched pair group without rehabilitation. When PM SAH was compared to the standard population, a reduction in quality of life was identified in physical items (role limitations because of physical health problems, physical functioning) as well as in psychological items (role limitations because of emotional problems). Subsequent rehabilitation on PM SAH patients probably leads to an increase in independence and better mRs. While better mRs was shown at discharge in patients without subsequent rehabilitation, the mRs of rehabilitants was nearly identical after rehabilitation. Patients with good mRs also reached high levels of health-related quality of life (HRQoL) without rehabilitation. Thus, subsequent rehabilitation needs to be encouraged on an individual basis. Indication criteria for subsequent rehabilitation should be defined in further studies to improve patient treatment and efficiency in health care.
在约25%的自发性蛛网膜下腔出血（SAH）患者中，放射学诊断期间无法确定出血源。一般来说，中脑周围或脑桥前（PM）SAH的预后明显优于非PM SAH。关于身心健康的长期随访数据很少，因此本研究报告长期结果。我们在六个月后测量了PM SAH对改良Rankin（mRs）生活质量量表的影响。对于长期随访，使用了SF-36问卷。问卷在发病后18至168个月发出。37例患者可进行长期随访（SAH后长达14年）。将SF-36问卷检测到的数据与标准人群的参考适用性进行比较。总共纳入37例患者进行进一步分析，并分为2个亚组；13例患者（35%）在临床住院后接受了后续康复治疗，24例（65%）未接受。在短期结果中，接受后续康复治疗的患者从出院到随访有显著改善，但未接受康复治疗的配对组则没有。当将PM SAH与标准人群进行比较时，发现身体项目（因身体健康问题导致的角色限制、身体功能）以及心理项目（因情绪问题导致的角色限制）的生活质量有所下降。PM SAH患者的后续康复可能会提高独立性并改善mRs。虽然未接受后续康复治疗的患者出院时mRs较好，但康复患者康复后的mRs几乎相同。mRs良好的患者在未接受康复治疗的情况下也达到了较高的健康相关生活质量（HRQoL）水平。因此，应鼓励根据个体情况进行后续康复治疗。后续康复治疗的指征标准应在进一步研究中确定，以改善患者治疗和医疗保健效率。
