当院の急性期脳梗塞診療における COVID-19 の影響

新型コロナウイルス感染症 (COVID-19) の流行は脳卒中診療にも大きな影響を与えた.特に COVID-19 流行後の当院の acute ischemic stroke (AIS) 診療プロトコルでは感染拡大防止を最優先する目的で,画像検査前に迅速抗原検査の陰性確認を要するため治療開始の遅延が危惧された.COVID-19 流行によるプロトコルの改定が当院での AIS 治療にどのような影響を与えたかについて,COVID-19 流行前(2018 年 10 月から 2020 年 3 月)と流行後(2020 年 4 月から 2021 年 9 月)を対象とし比較を行った.AIS 救急搬送件数は流行前...

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Published in日大医学雑誌 Vol. 81; no. 6; pp. 341 - 346
Main Authors 熊川, 貴大, 龍岡, 樹里, 根岸, 弘, 吉野, 篤緒, 神谷, 光樹, 四條, 克倫, 吉田, 礼於那, 山室, 俊
Format Journal Article
LanguageJapanese
Published 日本大学医学会 01.12.2022
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Online AccessGet full text
ISSN0029-0424
1884-0779
DOI10.4264/numa.81.6_341

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Abstract 新型コロナウイルス感染症 (COVID-19) の流行は脳卒中診療にも大きな影響を与えた.特に COVID-19 流行後の当院の acute ischemic stroke (AIS) 診療プロトコルでは感染拡大防止を最優先する目的で,画像検査前に迅速抗原検査の陰性確認を要するため治療開始の遅延が危惧された.COVID-19 流行によるプロトコルの改定が当院での AIS 治療にどのような影響を与えたかについて,COVID-19 流行前(2018 年 10 月から 2020 年 3 月)と流行後(2020 年 4 月から 2021 年 9 月)を対象とし比較を行った.AIS 救急搬送件数は流行前 73 症例,流行後102 症例であった.Door to image time は流行後で有意に延長していた ( p < 0.05).しかし Door to puncture time,puncture to recanalization time に有意な変化は認めなかった.この要因として MRI などの一部の画像検査を省略するなど速やかに治療介入ができるようにプロトコルを作成,改訂した結果と考えられた.
AbstractList 新型コロナウイルス感染症 (COVID-19) の流行は脳卒中診療にも大きな影響を与えた.特に COVID-19 流行後の当院の acute ischemic stroke (AIS) 診療プロトコルでは感染拡大防止を最優先する目的で,画像検査前に迅速抗原検査の陰性確認を要するため治療開始の遅延が危惧された.COVID-19 流行によるプロトコルの改定が当院での AIS 治療にどのような影響を与えたかについて,COVID-19 流行前(2018 年 10 月から 2020 年 3 月)と流行後(2020 年 4 月から 2021 年 9 月)を対象とし比較を行った.AIS 救急搬送件数は流行前 73 症例,流行後102 症例であった.Door to image time は流行後で有意に延長していた ( p < 0.05).しかし Door to puncture time,puncture to recanalization time に有意な変化は認めなかった.この要因として MRI などの一部の画像検査を省略するなど速やかに治療介入ができるようにプロトコルを作成,改訂した結果と考えられた.
Author 根岸, 弘
神谷, 光樹
山室, 俊
吉田, 礼於那
龍岡, 樹里
四條, 克倫
吉野, 篤緒
熊川, 貴大
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4) Khosravani H, Rajendram P, Notario L, et al. Protected code stroke: hyperacute stroke management during the coronavirus disease 2019 (COVID-19) pandemic. Stroke 2020; 51: 1891– 1895.
2) Li Y, Li M, Wang M, et al. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observa tional study. Stroke Vasc Neurol 2020; 5: 279–284.
19) Shokri H, Nahas NE, Basiony AE, et al. Did COVID-19 impact stroke services? A multicenter study. Neurol Sci 2022 Mar 25: 1–8. doi:10.1007/s10072-022-06018-7. Epub ahead of print.
3) Zhou Y, Li W, Wang D, et al. Clinical time course of COVID19, its neurological manifestation and some thoughts on its management. Stroke Vasc Neurol 2020; 5: 177–179.
16) Bourcier R, Goyal M, Liebeskind DS, et al. Association of time from stroke onset to groin puncture with quality of reperfusion after mechanical thrombectomy: A Meta-Analysis of individual patient data from 7 randomized clinical trials. JAMA Neurol 2019; 76: 405–411.
11) Bres Bullrich M, Fridman S, Mandzia JL, et al. COVID-19: stroke admissions, emergency department visits, and preven tion clinic referrals. Can J Neurol Sci 2020; 47: 693–696.
18) Frisullo G, Brunetti V, Di Iorio R, et al. STROKE TEAM Collaborators. Effect of lockdown on the management of ischemic stroke: an Italian experience from a COVID hospital. Neurol Sci 2020; 41: 2309–2313.
5) 日本脳卒中学会,COVID-19 対策プロジェクトチーム,JSS-PCS 作成ワーキンググループ.COVID-19 対応脳卒 中プロトコル(日本脳卒中学会版Protected Code Stroke: JSS-PCS).脳卒中 2020; 42: 315–343.
1) Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020; 77: 683–690.
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14) Tejada Meza H, Lambea Gil Á, Saldaña AS, et al. the NORDICTUS Investigators. Impact of COVID-19 outbreak on ischemic stroke admissions and in-hospital mortality in North-West Spain. Int J Stroke 2020; 15: 755–762.
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17) Naragum V, Jindal G, Miller T, et al. Functional Independence After Stroke Thrombectomy Using Thrombolysis In Cerebral Infarction Grade 2c: A New Aim of Successful Revascularization. World Neurosurg 2018; 119: 928–933.
20) Teo KC, Leung WCY, Wong YK, et al. Delays in stroke onset to hospital arrival time during COVID-19. Stroke 2020; 51: 2228–2231.
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References_xml – reference: 10) Pandey AS, Daou BJ, Tsai JP, et al. Letter: COVID-19 pandemic–the bystander effect on stroke care in Michigan. Neurosurgery 2020; 87: E397–E399.
– reference: 2) Li Y, Li M, Wang M, et al. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observa tional study. Stroke Vasc Neurol 2020; 5: 279–284.
– reference: 20) Teo KC, Leung WCY, Wong YK, et al. Delays in stroke onset to hospital arrival time during COVID-19. Stroke 2020; 51: 2228–2231.
– reference: 7) 「新型コロナウイルス感染症対策サイト,都内の最新感染動向」(東京都)https://stopcovid19.metro.tokyo.lg.jp/
– reference: 16) Bourcier R, Goyal M, Liebeskind DS, et al. Association of time from stroke onset to groin puncture with quality of reperfusion after mechanical thrombectomy: A Meta-Analysis of individual patient data from 7 randomized clinical trials. JAMA Neurol 2019; 76: 405–411.
– reference: 18) Frisullo G, Brunetti V, Di Iorio R, et al. STROKE TEAM Collaborators. Effect of lockdown on the management of ischemic stroke: an Italian experience from a COVID hospital. Neurol Sci 2020; 41: 2309–2313.
– reference: 11) Bres Bullrich M, Fridman S, Mandzia JL, et al. COVID-19: stroke admissions, emergency department visits, and preven tion clinic referrals. Can J Neurol Sci 2020; 47: 693–696.
– reference: 14) Tejada Meza H, Lambea Gil Á, Saldaña AS, et al. the NORDICTUS Investigators. Impact of COVID-19 outbreak on ischemic stroke admissions and in-hospital mortality in North-West Spain. Int J Stroke 2020; 15: 755–762.
– reference: 8) Holmes JL, Brake S, Docherty M, et al. Emergency ambulance services for heart attack and stroke during UK’s COVID-19 lockdown. Lancet 2020; 395: e93–e94.
– reference: 19) Shokri H, Nahas NE, Basiony AE, et al. Did COVID-19 impact stroke services? A multicenter study. Neurol Sci 2022 Mar 25: 1–8. doi:10.1007/s10072-022-06018-7. Epub ahead of print.
– reference: 9) Kansagra AP, Goyal MS, Hamilton S, et al. Collateral effect of Covid-19 on stroke evaluation in the United States. N Engl J Med 2020; 383: 400–401.
– reference: 15) Aoki J, Kimura K, Koga M, et al. NIHSS-time score easily predicts outcomes in rt-PA patients: the SAMURAI rt-PA registry. J Neurol Sci 2013; 3327: 6–11.
– reference: 12) Kristoffersen ES, Jahr SH, Faiz KW, et al. Stroke admission rates before, during and after the first phase of the COVID-19 pandemic. Neurol Sci 2021; 42: 791–798.
– reference: 6) Caceres JA, Adil MM, Jadhav V, et al. Diagnosis of stroke by emergency medial dispatchers and its impact on the prehospi tal care of patients. J stroke Cerebrovasc Dis 2013; 22: e610– e614.
– reference: 4) Khosravani H, Rajendram P, Notario L, et al. Protected code stroke: hyperacute stroke management during the coronavirus disease 2019 (COVID-19) pandemic. Stroke 2020; 51: 1891– 1895.
– reference: 1) Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020; 77: 683–690.
– reference: 13) Nguyen TTM, van den Wijngaard IR, Bosch J, et al. Comparison of prehospital scales for predicting large anterior vessel occlusion in the ambulance setting. JAMA Neurol 2021; 78: 157–164.
– reference: 17) Naragum V, Jindal G, Miller T, et al. Functional Independence After Stroke Thrombectomy Using Thrombolysis In Cerebral Infarction Grade 2c: A New Aim of Successful Revascularization. World Neurosurg 2018; 119: 928–933.
– reference: 21) Montaner J, Barragán-Prieto A, Pérez-Sánchez S, et al. Break in the stroke chain of survival due to COVID-19. Stroke 2020; 51: 2307–2314.
– reference: 3) Zhou Y, Li W, Wang D, et al. Clinical time course of COVID19, its neurological manifestation and some thoughts on its management. Stroke Vasc Neurol 2020; 5: 177–179.
– reference: 5) 日本脳卒中学会,COVID-19 対策プロジェクトチーム,JSS-PCS 作成ワーキンググループ.COVID-19 対応脳卒 中プロトコル(日本脳卒中学会版Protected Code Stroke: JSS-PCS).脳卒中 2020; 42: 315–343.
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Snippet 新型コロナウイルス感染症 (COVID-19) の流行は脳卒中診療にも大きな影響を与えた.特に COVID-19 流行後の当院の acute ischemic stroke (AIS) 診療プロトコルでは感染拡...
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SubjectTerms COVID-19
Door to image time
急性虚血性脳卒中
Title 当院の急性期脳梗塞診療における COVID-19 の影響
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