Long-term outcomes, including the survival rate and period to death, in patients over 80 years old after ruptured cerebral aneurysm clipping.
Long-term outcomes, including the survival rate and period to death, in patients over 80 years old after ruptured cerebral aneurysm clipping.
复制标题
80 岁以上患者脑动脉瘤破裂夹闭术后的长期结果，包括生存率和死亡时间。
DOI：
10.1016/j.jstrokecerebrovasdis.2022.106691
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Ogasawara K.
中科院分区：
文献类型：
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作者：
Kubo Y;Koji T;Fujiwara S;Chida K;Akamatsu Y;Kashimura H;Ogasawara K.
目的：本研究旨在确定80岁以上接受前循环动脉瘤破裂手术夹持的患者的长期预后，包括生存率、死亡时间、死亡原因和不良预后预测因素。材料与方法本回顾性观察研究对1994年4月1日至2019年6月30日患者的病历进行评估。所有患者在蛛网膜下腔出血（SAH）发生后72小时内均行手术夹持术。收集患者、SAH和结果的信息。结果所有患者的平均住院时间为54.5天，长期随访时间为53.3个月。改良Rankin评分（mRS）为4-5的患者出院时死亡时间明显短于mRS为0-3的患者（p=0.001）。Kaplan-Meier法使用log-rank检验显示，出院时mRS为4-5的患者的生存率明显低于出院时mRS为0-3的患者（p<0.05）。单因素分析显示，在出院时，mRS为4-5级的患者中，Hunt和Hess分级及手术并发症的比例明显高于mRS为0-3级的患者（p=0.0013和0.011）。多因素分析显示，手术并发症的存在是不良预后的唯一独立预测因素（p=0.043，优势比[OR] 7.937, 95%可信区间[CI] 1.061 ~ 59.38）。Kaplan-Meier法采用log-rank检验显示，有手术并发症的患者生存率明显低于无手术并发症的患者（p<0.05）。结论尤其在80岁以上的患者中，H-H 2级且临床条件良好的患者可选择手术夹持，避免手术并发症是达到良好效果的关键。
ObjectiveThis study aimed to identify the long-term outcomes, including the survival rate, period to death, causes of death, and predictors of poor outcomes, in patients aged over 80 years who underwent surgical clipping for a ruptured anterior circulation aneurysm.Materials and MethodsIn this retrospective observational study, the medical records of patients from April 1, 1994, to June 30, 2019, were evaluated. All patients underwent surgical clipping within 72 h of subarachnoid hemorrhage (SAH) onset. Information on the patient, SAH, and outcomes were collected.ResultsThe mean hospitalization and long-term follow-up periods for all patients were 54.5 days and 53.3 months, respectively. The period to death was significantly shorter in patients with modified Rankin scale (mRS) of 4–5 than for those with an mRS of 0–3 at discharge (p=0.001). The Kaplan–Meier method using the log-rank test demonstrated that patients with an mRS of 4–5 at discharge had a significantly lower survival rate compared to those with an mRS of 0–3 at discharge (p<0.05). Univariate analysis revealed that the proportion of patients with Hunt and Hess grade and presence of surgical complications were significantly larger in the group with an mRS of 4–5 than in that with an mRS of 0–3 at discharge (p=0.0013 and 0.011, respectively). Multivariate analysis demonstrated that presence of surgical complications was the only independent predictor of poor outcomes (p=0.043, odds ratio [OR] 7.937, 95% confidence interval [CI] 1.061–59.38). The Kaplan-Meier method using the log-rank test demonstrated that patients with surgical complications had a significantly lower survival rate compared to those with no surgical complications (p<0.05).ConclusionsEspecially in patients aged over 80 years, those with H-H grade 2 and a good clinical condition can be candidates for surgical clipping, whereas avoiding surgical complications is essential for achieving good outcomes.