はじめに 対象と方法 39: , 2017 SAH 183 WFNS

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1 39:107 原 著 39: , 要旨 SAH SAH WFNS I III 72.7 Fisher CT GR MD WFNS Key words: subarachnoid hemorrhage, prognosis, rate of home return, referral system for stroke, liaison critical pathway はじめに aneurysmal subarachnoid hemorrhage: SAH 5.6 mrs modified Rankin Scale SAH 対象と方法 SAH Fig. 1 WFNS Fisher CT doi: /jstroke GOS Consensus Day D-CTA 1/3 FIM Functional Independence Measure BI Barthal Index GR FIM BI MD FIM BI SD FIM BI 5 50 VS FIM 18 BI 0 Fisher s exact test

2 39:108 脳卒中 Fig. 1 Recruitment into the study. P 0.05 結果 ± ± WFNS I 47.0 II 22.4 III 3.8 IV 17.5 V 9.8 Fisher CT ACA 39.9 ICA 27.9 MCA 29.5 VABA / / / / Table 1 GOS n=183 GR 38.3 MD 18.6 SD 25.9 VS 12.0 D / / Fig. 1 GOS n=163 GR 63.7 MD 9.5 SD 3.1 VS 7.1 D 6.5 Fig. 2 n= GR/MD / Fig WFNS V Table 2 考察 ADL

3 39:109 Table 1 Clinical features of patients All cases 183 Female sex 129 (70%) Median age, y (IQR) 64 (27 93) Median in-hospital days (IQR) 21 (2 63) WFNS Grade I: 86 (47.0%) II: 41 (22.4%) III: 6 (3.3%) IV: 32 (17.5%) V: 18 (9.8%) Fisher CT classification Group 2: 8 (4.4%) Group 3: 158 (86.3%) Group 4: 17 (9.3%) Location of aneurysms ACA: 73 (39.9%) ICA: 51 (27.9%) MCA: 54 (29.5%) VABA: 5 (2.7%) Symptomatic VS 35/176 (19.9%) (NA7) Angiographic VS 63/108 (58.3%) (NA75) Cerebral infarction 29/175 (16.6%) (NA8) Hydrocephalus (Shunt Op) 28/175 (16.0%) (NA8) ACA: anterior cerebral artery, ICA: internal cerebral artery, IQR: Interquartile range, MCA: middle cerebral artery, Op: operation, VABA: vertebral artery and basilar artery, VS: vasospasm, WFNS: World Federation of Neurosurgical Surgeons SAH SAH SAH Fig. 2 Outcome (A) and Living place in the final of life (B).

4 39:110 脳卒中 Table 2 Comparison between home return patients and non-home return patients Home return patients (N=128) Non-home return patients (N=47) p Value OR on multivariable analysis Female sex (%) 93/128 (72.6) 30/47 (63.8) 0.26 Median age, y (IQR) 63 (27 93) 69 (51 91) <0.001 Decade (%) Under 49s 29/128 (22.7) 0/47 (0.0) < s 20/128 (15.6) 7/47 (14.9) s 46/128 (35.9) 17/47 (36.2) s 22/128 (17.2) 9/47 (19.1) 0.76 Over 80s 11/128 (8.0) 14/47 (29.8) < ( ) WFNS Grade (%) I 79/128 (61.7) 6/47 (12.8) <0.001 II 23/128 (18.0) 15/47 (31.9) <0.05 III 2/128 (1.6) 2/47 (4.3) 0.29 IV 20/128 (15.6) 11/47 (23.4) 0.23 V 4/128 (3.1) 13/47 (27.7) < ( ) Fisher group (%) 2 7/128 (5.5) 1/47 (2.1) /128 (87.5) 39/47 (83.0) /128 (7.0) 7/47 (14.9) 0.11 Location of aneurysm (%) ACA 50/128 (39.1) 19/47 (40.4) 0.87 ICA 36/128 (28.1) 14/47 (29.8) 0.83 MCA 39/128 (30.5) 13/47 (27.7) 0.72 VABA 3/128 (2.3) 1/47 (2.1) 0.93 Median in-hospital days (IQR) 20 (12 44) 26 (2 63) <0.001 Symptomatic VS (%) 20/128 (15.6) 12/40 (30) <0.005 Angiographic VS (%) 40/79 (50.6) 18/40 (45) 0.56 Cerebral infarction (%) 11/128 (8.6) 15/40 (37.5) < ( ) Hydrocephalus, Op (%) 9/128 (7.0) 16/39 (41.0) < ( ) ACA: anterior cerebral artery, ICA: internal cerebral artery, IQR: interquartile range, MCA: middle cerebral artery, Op: operation, OR: odds ratio, VABA: vertebral artery and basilar artery, VS: vasospasm, WFNS: World Federation of Neurosurgical Surgeons Asterisk ( ) indicates significant difference 2 SAH 73.1 SAH SAH 70

5 39:111 SAH 80 WFNS G Fisher 4 SAH 7 9 WHNS ADL おわりに SAH 73.1 謝 COI COI 辞 参考文献 , pp : , Shirao S, Yoneda H, Ishihara H, et al: A proposed definition of symptomatic vasospasm based on treatment of cerebral vasospasm after subarachnoid hemorrhage in Japan: Consensus 2009, a project of the 25 Spasm Symposium. Surg Neurol Int 2: 74, K-STREAM Jpn J Rehabil Med 50: , : , : , : , 2014

6 39:112 脳卒中 Abstract Present situation of the prognosis and the rate of home return in patients with aneurysmal subarachnoid hemorrhage in our hospital using Database of Referral System for Stroke in Kumamoto Shu Hasegawa, M.D., Ph.D., 1) Tadashi Terasaki, M.D., 2) Kazutaka Ohta, M.D., Ph.D., 1) Yutaka Ueda, M.D., Ph.D., 1) Takashi Itoyama, M.D., 1) and Masaki Miura, M.D., Ph.D. 1) 1) Department of Neurosurgery, Kumamoto Red Cross Hospital 2) Department of Neurology, Kumamoto Red Cross Hospital Background and Purpose: We evaluated the present situation of the prognosis and the rate of home return in patients with aneurysmal subarachnoid hemorrhage (SAH) in our hospital. Methods: The 183 out of 253 SAH patients who underwent surgical treatments in our hospital from January 2010 to December 2013 were included in this study. Clinical data of the patients were collected from the Database of Referral System for Stroke in Kumamoto. Results: The median age of the patients was 64 years and 70% of them were women. On admission, 72.7% patients were present under grade III in World Federation of Neurosurgical Surgeons (WFNS) grading and there were 86.3% in CT Fisher group 3. A part of patients suffered from symptomatic vasospasm (19.9%), cerebral infarction (16.6%), and hydrocephalus (16%) with surgical treatments. The patients with good recovery and moderate disability at discharge from our hospital were 73.2%, and 73.1% of SAH patients could return to their home. Over the age of 80, WFNS grading, symptomatic vasospasm, cerebral infarction, and hydrocephalus were independent factors regarding the determinant factor for the home return. Conclusion: Although the prognosis of SAH is thought to be poor, our patients showed relatively good course at discharge. We suggest that it is important to carry out a multidisciplinary therapy against cerebral vasospasm, cerebral infarction, and hydrocephalus, all of which were determinant factors for the prognosis of our patients. In addition, it is also important to establish a seamless rehabilitation in recovery phase of the patients. Key words: subarachnoid hemorrhage, prognosis, rate of home return, referral system for stroke, liaison critical pathway (Jpn J Stroke 39: , 2017)