Uticaj vremena operacije na rani funkcionalni i kognitivni oporavak nakon aneurizmatskog subarahnoidnog krvarenja: uloga rane rehabilitacije
Sažetak
Uvod/Cilj. Subarahnoidno aneurizmatsko krvarenje (aneurysmal subarachnoid hemorrhage – aSAH) predstavlja kritično stanje sa značajnim funkcionalnim i kognitivnim posledicama. Pitanje optimalnog vremena za hiruršku intervenciju i dalje je kontroverzno, posebno u odnosu na rani opravak bolesnika. Cilj rada bio je da se ispita rani funkcionalni i kognitivni opravak kod bolesnika operisanih u ranom i odloženom terminu, uključenih u standardni rani rehabilitacioni program. Metode. Ova prospektivna kohortna studija jednog centra obuhvatila je 114 bolesnika operisanih zbog rupture intrakranijalne aneurizme u periodu od novembra 2022. do novembra 2023. godine. Bolesnici su podeljeni u dve grupe: rano operisane, kojima je operacija izvršena u roku od tri dana nakon rupture aneurizme, i odloženo operisane, kod kojih je operacija obavljena u terminu dužem od tri dana nakon rupture. Funkcionalni status procenjivan je upotrebom skale za procenu funkcionalne nezavisnosti (Functional Independence Measure – FIM), a kognitivni status upotrebom Mini-Mental State Examination (MMSE) testa. Oba testa primenjena su na početku i završetku ranog programa rehabilitacije. Metode deskriptivne i inferencijalne statistike (Wilcoxon signed-rank test, split-plot analysis of variance) korišćene su za analizu podataka. Rezultati. Tokom sprovođenja ranog rehabilitacionog programa u obe grupe je postignuto statistički značajno poboljšanje rezultata funkcionalnog i kognitivnog statusa (p < 0,001). Najveće poboljšanje postignuto je u FIM motornoj podskali. Na otpustu, rano operisani bolesnici postigli su značajno veće FIM motorne i ukupne rezultate u odnosu na odloženo operisane (p = 0,024, p = 0,037, redom). Nije bilo statistički značajne razlike između grupa u MMSE i FIM kognitivnim rezultatima. Stepen krvarenja značajno je uticao na promene u FIM i MMSE rezultatima. Godine starosti, dužina boravka u bolnici, kao i vremenski period do započinjanja rehabilitacije nisu značajno uticali na oporavak bolesnika. Zaključak. Rana hirurška intervencija za aSAH, udružena sa standardizovanim programom rehabilitacije, povezana je sa boljim ranim motornim funkcionalnim oporavkom bolesnika, u odnosu na odloženu operaciju. Za bolesnike operisane u odloženom periodu može biti potrebna primena individualizovanih strategija rehabilitacije.
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