Long-term functional prognosis of patients with aneurysmal subarachnoid hemorrhage treated with rehabilitation combined with hyperbaric oxygen: Case-series study.

Abstract

The long-term prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH) has received increasing attention in recent years. Hyperbaric oxygen and rehabilitation are already used in clinical treatment of patients with aSAH, but it is unclear whether it can improve the long-term prognosis of patients postoperation. The purpose of this study was to evaluate the long-term prognosis and prognostic factors associated with combined rehabilitation and hyperbaric oxygen therapy for patients with aSAH.Information were retrospectively collected from patients with aSAH treated from October 2014 to July 2017, including demographics, history of hypertension, Hunt–Hess Grade at the time of onset, location of aneurysm, surgical treatment, status of delayed cerebral ischemia and tracheotomy, level of consciousness impairment (Glasgow Coma scale [GCS], neurologic function damage (National Institutes of Health Stroke Scale [NIHSS]), status of hydrocephalus, time of initial hyperbaric oxygen and rehabilitation therapy, as well as duration and frequency of hyperbaric oxygen therapy, and so on. Long-term functional prognosis was measured by modified Rankin scale (mRS), and mRS ≤3 was defined as good prognosis. Univariate and multivariate logistic regression were used to analyze predictors associated with poor prognosis.A total of 44 patients with aSAH were enrolled, and 25 patients (56.8%) had a good functional prognosis 6 months after disease onset. Univariate analysis showed age (P = .028), hyperbaric oxygen and rehabilitation start time (P = .039), NIHSS (P = .000), hydrocephalus (P = .024), frequency of hyperbaric oxygen therapy (P = .016), GCS ≤8 points (P = .000), and tracheotomy (P = .007) were associated with prognosis. Multivariate logistic regression analysis showed that only a higher NIHSS score was an independent predictor of poor prognosis (odds ratio = 1.59; 95% confidence interval, 1.10–2.30).More than 50% of patients with aSAH can achieve a good functional prognosis after combined rehabilitation and hyperbaric oxygen therapy. The severity of neurological impairment before treatment is closely related to poor prognosis.