Auer L M, Gallhofer B, Ladurner G, Heppner F, Lechner H
Wien Klin Wochenschr. 1980 Dec 19;92(24):871-5.
This report presents an evaluation of prognosis in 227 patients with subarachnoid haemorrhage caused by intracranial aneurysm, comparing operative treatment in 118 patients with conservative treatment in 109. In all operable cases, the prognosis following early surgery was better than that of conservative treatment. Statistical comparison of patient groups according to the clinical condition allowed the formation of guidelines for the optimal timing of surgery: patients in good clinical condition should be operated on at the earliest possible moment. The overall mortality with such a policy is lower than with a waiting policy, since the majority of recurrences occurred within 2 weeks. Patients with disturbed consciousness and neurological deficit are best operated on either within 24 hours or following stabilization or improvement of the clinical picture -- mostly after 2 weeks. The risk of rebleeding is much lower in these cases, which justifies awaiting optimum clinical conditions. Surgery on comatose patients is contraindicated.
本报告对227例颅内动脉瘤所致蛛网膜下腔出血患者的预后进行了评估，比较了118例手术治疗患者和109例保守治疗患者的情况。在所有可手术的病例中，早期手术后的预后优于保守治疗。根据临床状况对患者组进行统计学比较，形成了手术最佳时机的指导原则：临床状况良好的患者应尽早手术。采用这种策略的总体死亡率低于等待策略，因为大多数复发发生在2周内。意识障碍和神经功能缺损的患者最好在24小时内手术，或在临床症状稳定或改善后手术——大多在2周后。这些病例中再出血的风险要低得多，这证明等待最佳临床状况是合理的。昏迷患者禁忌手术。
