Kaste M, Troupp H
Br Med J. 1978 May 20;1(6123):1310-1. doi: 10.1136/bmj.1.6123.1310.
During 1964-9, 178 patients with subarachnoid haemorrhage from a single intracranial arterial aneurysm were allocated at random to receive operative or conservative treatment at an average of seven weeks after bleeding. During the follow-up fatal rebleeding episodes occurred in six of the 86 patients treated surgically and 16 of the 92 treated conservatively. This difference was significant. Fatal rebleeding occurred on average 40 months after the first episode. Deaths from all causes occurred in 17 of the 86 patients treated surgically and 22 of the 92 treated conservatively. Life-table analysis of the chances of surviving 1, 5, and 11 years gave probabilities of 95 and 91%, 87 and 86%, and 76 and 75% in the two treatment groups respectively. Of the 139 patients alive after a mean follow-up of nine years, 130 (94%) were fully independent in their daily lives, and only 43 (31%) were unable to work. The method of treatment did not affect the quality of survival.The results show that fatal rebleeding may occur even many years after the first episode. Nevertheless, if the patient is in good condition seven weeks after a haemorrhage from a single intracranial arterial aneurysm the outcome is good irrespective of whether operation is performed at this late stage.
在1964年至1969年期间，178例因单一颅内动脉瘤导致蛛网膜下腔出血的患者在出血后平均7周时被随机分配接受手术治疗或保守治疗。在随访期间，86例接受手术治疗的患者中有6例发生致命性再出血，92例接受保守治疗的患者中有16例发生致命性再出血。这种差异具有统计学意义。致命性再出血平均发生在首次出血后40个月。86例接受手术治疗的患者中有17例因各种原因死亡，92例接受保守治疗的患者中有22例死亡。对1年、5年和11年生存机会的生命表分析显示，两个治疗组的生存概率分别为95%和91%、87%和86%、76%和75%。在平均随访9年后仍存活的139例患者中，130例（94%）在日常生活中完全独立，只有43例（31%）无法工作。治疗方法不影响生存质量。结果表明，即使在首次出血多年后仍可能发生致命性再出血。然而，如果患者在单一颅内动脉瘤出血后7周时情况良好，无论在这个晚期是否进行手术，预后都很好。
