Improvement of quality of life in patients surgically treated for asymptomatic unruptured intracranial aneurysms
Improvement of quality of life in patients surgically treated for asymptomatic unruptured intracranial aneurysms
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DOI：
10.1136/jnnp.2006.098871
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发表时间：
2007-05-01
影响因子：
11
通讯作者：
Fujioka, Shodo
中科院分区：
文献类型：
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作者：
Yamashiro, Shigeo;Nishi, Toru;Fujioka, Shodo
目的：比较67例无症状未破裂颅内动脉瘤（ICA）患者术前、术后的生活质量（QOL）和心理状态，方法：采用简明生活质量量表（SF-36）对61例ICA患者行ICA夹闭术，并对61例ICA患者进行QOL和心理状态的评估。分别于治疗前、治疗后3个月、治疗后1年、治疗后3年采用医院焦虑抑郁量表（HADS）评定患者的心理状态。除身体疼痛外，研究人群的8个SF-36领域的术前平均评分均显著低于参考人群。14例（20.9%）患者在手术后30天内发生手术并发症，定义为神经功能恶化和/或异常CT结果。尽管有一些并发症，但所有手术患者的生活质量在治疗后3年恢复到参考人群的平均水平。术后3个月，心理社会活动和总体健康感知评分暂时低于术前水平。根据HADS，患者经历了轻度焦虑手术前，它消失了术后第三个月。结论：术前，未破裂的ICA患者的生活质量显着下降。择期手术后进一步短暂下降，但在3年内恢复到参考人群记录的平均水平。我们的研究结果表明，这些患者从手术中获得了显着的生活质量益处。因此，在决定治疗相关风险及其自然史（如潜在破裂）是否需要手术治疗无症状未破裂ICA时，应考虑主观QOL问题。
Objective: To compare the preoperative and postoperative health-related quality of life (QOL) and psychological state of patients with asymptomatic unruptured intracranial aneurysms (ICAs) who underwent elective surgery.Methods: Out of 67 patients who underwent neck clipping of ICAs, we assessed the QOL of 61 patients using Short Form-36 (SF-36); their psychological state was rated on the Hospital Anxiety and Depression Scale (HADS) before, 3 months, and 1 and 3 years after treatment.Results: The preoperative mean scores for each of the eight SF-36 domains except bodily pain were significantly lower in the study population than in the reference population. 14 (20.9%) patients experienced surgical complications defined as neurological deterioration and/or abnormal CT findings within 30 days of the operation. Despite some complications, the QOL of all operated patients returned to the mean level of the reference population 3 years after treatment. At 3 months after surgery, the scores for psychosocial activities and general health perception were transiently below the preoperative levels. According to the HADS, the patients experienced mild anxiety before the operation; it disappeared by the third postoperative month.Conclusions: Preoperatively, patients with unruptured ICAs reported a significantly decreased QOL. It further declined transiently after elective surgery, but it returned to the mean level recorded for the reference population within 3 years. Our findings suggest that these patients derived significant QOL benefits from their surgery. Hence subjective QOL issues should be considered in deciding whether treatment-related risks and their natural history, such as their potential rupture, warrant surgery of asymptomatic unruptured ICAs.