Functional Outcome After Poor-Grade Subarachnoid Hemorrhage: A Single-Center Study and Systematic Literature Review
Functional Outcome After Poor-Grade Subarachnoid Hemorrhage: A Single-Center Study and Systematic Literature Review
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DOI：
10.1007/s12028-016-0305-3
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发表时间：
2016-12-01
影响因子：
3.5
通讯作者：
Macdonald, R. Loch
中科院分区：
文献类型：
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作者：
de Oliveira Manoel, Airton Leonardo;Mansur, Ann;Macdonald, R. Loch
低级别蛛网膜下腔出血（SAH）（世界神经外科学会联合会分级4级和5级）与高死亡率和不良功能预后相关。我们报道了一项低级别SAH患者的单中心队列研究，并结合了对低级别SAH患者功能结局研究的系统回顾。回顾性收集2009年至2013年期间接受治疗的低度SAH患者队列数据，并结合系统评价（从开始到2015年11月；PubMed, Embase）。两位审稿人根据预先确定的纳入标准独立评估了这些研究：连续的低级别SAH，出血后至少3个月测量的功能结局，以及在动脉瘤治疗前死亡的患者报告。我们检索了329篇出版物，其中23篇符合我们的纳入标准，从1977年到2014年在10个国家招募了2713名受试者（包括179名来自我们队列的不良患者）。死亡率为60%（1683例），其中动脉瘤治疗前死亡806例（29%），动脉瘤治疗后死亡877例（31%）。1775例（1775/2826- 63%）患者接受治疗：1347例（1347/1775- 76%），428例（428/1775- 24%）采用血管内治疗。794例（28%）患者预后良好，1867例（66%）患者预后不良。当这些研究按年代分组时，良好的结果从20世纪70年代末至80年代初的13%增加到20世纪80年代末至90年代初的35%，此后保持不变。尽管低度SAH患者的死亡率仍然很高，但大约三分之一的患者可以获得良好的功能预后。从1970年到1990年代，新的诊断方法的发展和治疗方法的实施可能是死亡率下降和功能结果改善的原因。此后功能结果的平稳期可能是由于对病情较重和老年患者的治疗，以及缺乏针对SAH的新的治疗干预措施。
Poor-grade subarachnoid hemorrhage (SAH) (World Federation of Neurosurgical Societies grade 4 and 5) is associated with high mortality rates and unfavorable functional outcomes. We report a single-center cohort of poor-grade SAH patients, combined with a systematic review of studies reporting functional outcome in the poor-grade SAH population.Data on a cohort of poor-grade SAH patients treated between 2009 and 2013 were retrospectively collected and combined with a systematic review (from inception to November 2015; PubMed, Embase). Two reviewers assessed the studies independently based on predefined inclusion criteria: consecutive poor-grade SAH, functional outcome measured at least 3 months after hemorrhage, and the report of patients who died before aneurysm treatment.The search yielded 329 publications, and 23 met our inclusion criteria with 2713 subjects enrolled from 1977 to 2014 in 10 countries (including 179 poor-grade patients from our cohort). Mortality rate was 60 % (1683 patients), of which 806 (29 %) died before and 877 (31 %) died after aneurysm treatment, respectively. Treatment was undertaken in 1775 patients (1775/2826-63 %): 1347 by surgical clipping (1347/1775-76 %) and 428 (428/1775-24 %) by endovascular methods. Outcome was favorable in 794 patients (28 %) and unfavorable in 1867 (66 %). When the studies were grouped into decades, favorable outcome increased from 13 % in the late 1970s to early 1980s to 35 % in the late 1980s to early 1990s, and remained unchanged thereafter.Although mortality remains high in poor-grade SAH patients, a favorable functional outcome can be achieved in approximately one-third of patients. The development of new diagnostic methods and implementation of therapeutic approaches were probably responsible for the decrease in mortality and improvement in the functional outcome from 1970 to the 1990s. The plateau in functional outcome seen thereafter might be explained by the treatment of sicker and older patients and by the lack of new therapeutic interventions specific for SAH.