Differing perspectives on outcome after subarachnoid hemorrhage: The patient, the relative, the neurosurgeon
Differing perspectives on outcome after subarachnoid hemorrhage: The patient, the relative, the neurosurgeon
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DOI：
10.1097/00006123-200004000-00012
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发表时间：
2000-04-01
期刊：
影响因子：
4.8
通讯作者：
Goplen, GB
中科院分区：
文献类型：
--
作者：
Buchanan, KM;Elias, LJ;Goplen, GB
目的：为了更好地了解患者和亲属对蛛网膜下腔出血 (SAH) 手术后结果的看法，我们评估了神经外科医生根据格拉斯哥结果量表评定为“恢复良好”或“中度残疾”的患者的神经行为变化、心理困扰和家庭负担。方法：对 28 名接受手术治疗的患者进行异质样本分析。 动脉瘤或动静脉畸形引起的 SAH 及其亲属分别接受了半结构化访谈。他们还完成了形容词检查表的修订版，以评估他们对患者神经行为变化的看法，并完成了简短症状清单，以衡量他们自己的心理困扰。采用李克特应变量表和扎里特负担访谈法评估亲属的家庭负担水平。 结果：SAH 手术后约 19 个月，大多数患者报告出现显着的负面神经行为变化，以及就业、精力水平、对轻度压力源的耐受性、休闲活动以及社交和性关系方面的负面变化。患者和亲属均报告心理困扰程度增加，亲属报告家庭负担增加。患者亲属对酸性物质的看法不同，亲属报告的问题较多；结论：尽管神经外科医生将患者分类为“恢复良好”或“中度残疾”，但大多数接受 SAH 手术治疗的患者报告了心理社会和神经行为的变化，这些变化对他们来说是残疾的，并且给他们的家庭带来了负担。由经验丰富的临床医生单独访谈的患者和亲属可能会对 SAH 的结果提出不同的观点，但这些观点不一定是好的。
OBJECTIVE: To better understand patients' and relatives' views of outcome after surgery for subarachnoid hemorrhage (SAH), we evaluated neurobehavioral changes, psychological distress, and family burden of patients who had been considered by their neurosurgeon as having a "good recovery" or a "moderate disability," as rated on the Glasgow Outcome Scale.METHODS: A heterogeneous sample of 28 patients treated surgically for SAH from an aneurysm or an arteriovenous malformation and their relatives separately underwent a semistructured interview. They also completed a revised version of the Adjective Checklist to assess their perceptions of the patient's neurobehavioral changes and the Brief Symptom Inventory as a measure of their own psychological distress. Levels of family burden on the relatives were evaluated with a Likert strain scale and the Zarit Burden Interview.RESULTS: Approximately 19 months after surgery for SAH, the majority of the patients reported significant negative neurobehavioral changes and negative changes in employment, energy levels, tolerance to mild stressors, leisure activities, and social and sexual relationships. Patients and relatives both reported elevated levels of psychological distress, and the relatives reported elevated levels of family burden. Patients' acid relatives' perceptions differed, with the relatives reporting more problems; both viewed the patient's outcome more negatively than did the operating neurosurgeon.CONCLUSION: Despite the neurosurgeon's classification of patients as having a "good recovery" or "moderate disability," the majority of patients surgically treated for SAH reported psychosocial and neurobehavioral changes that were disabling for them and burdensome to their family. Patients and relatives who are interviewed separately by an experienced clinician may provide differing perspectives on SAH outcome that are not necessarily good.