Department of Neurosurgery, Saiseikai Utsunomiya Hospital.
Neurol Med Chir (Tokyo). 2024 Jul 15;64(7):266-271. doi: 10.2176/jns-nmc.2024-0024. Epub 2024 Jun 5.
It has been shown that living alone is one of the risk factors for unfavorable outcomes in ischemic stroke patients, mostly due to delay in receiving appropriate treatment. A single-center retrospective observational study was conducted to evaluate whether living alone was associated with unfavorable outcomes in aneurysmal subarachnoid hemorrhage (SAH) patients. Among 451 SAH patients admitted to our institution between January 2013 and December 2022, 43 patients who lived alone had sustained SAH at home (group A) and 329 patients who lived with family had sustained SAH at home (group F). The mortality rate (46.5% vs. 29.8%, p = 0.04) and a tendency for having unfavorable outcomes were higher in group A than in group F. The incidence of concomitant hydrocephalus was significantly higher in the former (37.2% vs. 21.3%, p = 0.03). Group A was further classified to the Able to Call (n = 15, group AC) and Unable to Call (n = 28, group UC) subgroups based on their ability to call for help by themselves. Group AC tended to have favorable outcomes (27% vs. 4%, p = 0.04). Treatment to obliterate a ruptured aneurysm had particularly been challenging in group UC, in which the accurate time of onset often remained unidentifiable: Their overall mortality was as high as 57% and their capability to undergo surgical/interventional treatment was only 67%. Perioperative complications resulting from delayed presentation had been common. Considering the present finding that most of those who lived alone could not call for help, further effort is warranted to facilitate early detection of those patients.
独居被认为是导致缺血性脑卒中患者预后不良的危险因素之一，主要是因为独居患者接受适当治疗的时间延迟。本单中心回顾性观察性研究旨在评估独居是否与颅内破裂动脉瘤性蛛网膜下腔出血（aSAH）患者的不良预后相关。2013 年 1 月至 2022 年 12 月期间，我院共收治了 451 例 aSAH 患者，其中 43 例独居患者（A 组）在家中发生持续性 aSAH，329 例与家人同住的患者（F 组）在家中发生持续性 aSAH。A 组的死亡率（46.5% vs. 29.8%，p = 0.04）和不良预后的发生率均高于 F 组。前者合并脑积水的发生率显著高于后者（37.2% vs. 21.3%，p = 0.03）。根据患者能否自行呼救，A 组进一步分为能够呼救的（n = 15，AC 组）和无法呼救的（n = 28，UC 组）亚组。AC 组的预后较好（27% vs. 4%，p = 0.04）。UC 组患者由于难以确定动脉瘤破裂的准确时间，因此，闭塞破裂动脉瘤的治疗极具挑战性。其总体死亡率高达 57%，接受手术/介入治疗的能力仅为 67%。由于就诊延迟导致的围手术期并发症较为常见。鉴于目前独居患者大多无法呼救的发现，应进一步努力促进对这些患者的早期发现。
