低分级动脉瘤性蛛网膜下腔出血后的生活质量。

Quality of Life After Poor-Grade Aneurysmal Subarachnoid Hemorrhage.

机构信息

Department of Neurosurgery, Inselspital, Bern University-Hospital, Bern, Switzerland.

Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland.

出版信息

Neurosurgery. 2023 May 1;92(5):1052-1057. doi: 10.1227/neu.0000000000002332. Epub 2023 Jan 4.

DOI:10.1227/neu.0000000000002332

PMID:36700700

Abstract

BACKGROUND

Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality and poor disability outcome. Data on quality of life (QoL) among survivors are scarce because patients with poor-grade aSAH are underrepresented in clinical studies reporting on QoL after aSAH.

OBJECTIVE

To provide prospective QoL data on survivors of poor-grade aSAH to aid clinical decision making and counseling of relatives.

METHODS

The herniation World Federation of Neurosurgical Societies scale study was a prospective observational multicenter study in patients with poor-grade (World Federation of Neurosurgical Societies grades 4 & 5) aSAH. We collected data during a structured telephone interview 6 and 12 months after ictus. QoL was measured using the EuroQoL - 5 Dimensions - 3 Levels (EQ-5D-3L) questionnaire, with 0 representing a health state equivalent to death and 1 to perfect health. Disability outcome for favorable and unfavorable outcomes was measured with the modified Rankin Scale.

RESULTS

Two hundred-fifty patients were enrolled, of whom 237 were included in the analysis after 6 months and 223 after 12 months. After 6 months, 118 (49.8%) patients were alive, and after 12 months, 104 (46.6%) patients were alive. Of those, 95 (80.5%) and 89 (85.6%) reached a favorable outcome with mean EQ-5D-3L index values of 0.85 (±0.18) and 0.86 (±0.18). After 6 and 12 months, 23 (19.5%) and 15 (14.4%) of those alive had an unfavorable outcome with mean EQ-5D-3L index values of 0.27 (±0.25) and 0.19 (±0.14).

CONCLUSION

Despite high initial mortality, the proportion of poor-grade aSAH survivors with good QoL is reasonably large. Only a minority of survivors reports poor QoL and requires permanent care.

摘要

背景

差级别的蛛网膜下腔出血（aSAH）与高死亡率和较差的残疾预后相关。关于幸存者生活质量（QoL）的数据很少，因为在报告 aSAH 后 QoL 的临床研究中，差级别的 aSAH 患者代表性不足。

目的

提供差级别的 aSAH 幸存者的前瞻性 QoL 数据，以辅助临床决策和亲属咨询。

方法

疝出世界神经外科学会联合会分级量表研究是一项针对差级别的（世界神经外科学会联合会分级 4 和 5 级）aSAH 患者的前瞻性观察性多中心研究。我们在发病后 6 个月和 12 个月通过结构化电话访谈收集数据。QoL 使用欧洲五维健康量表-3 级（EQ-5D-3L）问卷进行测量，其中 0 代表等同于死亡的健康状况，1 代表完全健康。有利和不利结局的残疾结局使用改良 Rankin 量表进行测量。

结果

共纳入 250 例患者，其中 237 例患者在 6 个月后和 223 例患者在 12 个月后纳入分析。6 个月后，118 例（49.8%）患者存活，12 个月后，104 例（46.6%）患者存活。其中，95 例（80.5%）和 89 例（85.6%）患者达到有利结局，平均 EQ-5D-3L 指数值分别为 0.85（±0.18）和 0.86（±0.18）。6 个月和 12 个月后，23 例（19.5%）和 15 例（14.4%）存活患者的不利结局，平均 EQ-5D-3L 指数值分别为 0.27（±0.25）和 0.19（±0.14）。