院外心停止症例を含めたGCS 3-4重症くも膜下出血症例の特徴とその予後
「はじめに」重症くも膜下出血は, 予後不良の疾患とされる. しかし, 近年のくも膜下出血に伴う血管攣縮の治療や周術期管理の進歩もあり, 積極的に脳動脈瘤の治療をすることにより予後良好例が比較的多くみられるようになり, 積極的な治療を勧める報告が散見される. しかし, 動脈瘤の精査や治療にいたらないような最重症例〔Glasgow Coma Scale (GCS) 3-4〕, 特に院外心停止 (out-of-hospital cardiac arrest : OHCA) 例は非常に予後不良である. 頭蓋内疾患によるOHCA例の原因はくも膜下出血が最も多く, これらの予後はきわめて不良である. OH...
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| Published in | 脳卒中の外科 Vol. 47; no. 3; pp. 174 - 178 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中の外科学会
2019
日本脳卒中の外科学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-5508 1880-4683 |
| DOI | 10.2335/scs.47.174 |
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| Abstract | 「はじめに」重症くも膜下出血は, 予後不良の疾患とされる. しかし, 近年のくも膜下出血に伴う血管攣縮の治療や周術期管理の進歩もあり, 積極的に脳動脈瘤の治療をすることにより予後良好例が比較的多くみられるようになり, 積極的な治療を勧める報告が散見される. しかし, 動脈瘤の精査や治療にいたらないような最重症例〔Glasgow Coma Scale (GCS) 3-4〕, 特に院外心停止 (out-of-hospital cardiac arrest : OHCA) 例は非常に予後不良である. 頭蓋内疾患によるOHCA例の原因はくも膜下出血が最も多く, これらの予後はきわめて不良である. OHCA例も含めた最重症の動脈瘤の部位や大きさを評価した報告は少ない. OHCA例を含めた最重症のくも膜下出血の動脈瘤の評価や予後因子を評価することは, 未破裂動脈瘤の治療適応の妥当性や最重症くも膜下出血の治療の指針決定に役立つと考えられる. |
|---|---|
| AbstractList | 「はじめに」重症くも膜下出血は, 予後不良の疾患とされる. しかし, 近年のくも膜下出血に伴う血管攣縮の治療や周術期管理の進歩もあり, 積極的に脳動脈瘤の治療をすることにより予後良好例が比較的多くみられるようになり, 積極的な治療を勧める報告が散見される. しかし, 動脈瘤の精査や治療にいたらないような最重症例〔Glasgow Coma Scale (GCS) 3-4〕, 特に院外心停止 (out-of-hospital cardiac arrest : OHCA) 例は非常に予後不良である. 頭蓋内疾患によるOHCA例の原因はくも膜下出血が最も多く, これらの予後はきわめて不良である. OHCA例も含めた最重症の動脈瘤の部位や大きさを評価した報告は少ない. OHCA例を含めた最重症のくも膜下出血の動脈瘤の評価や予後因子を評価することは, 未破裂動脈瘤の治療適応の妥当性や最重症くも膜下出血の治療の指針決定に役立つと考えられる. |
| Author | 寺田, 愛子 池田, 英敏 石黒, 友也 小宮山, 雅樹 岩井, 謙育 師岡, 誉也 |
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| References | 19) Yamada M, Kitahara T, Kurata A, et al : Intracranial vertebral artery dissection with subarachnoid hemorrhage: clinical characteristics and outcomes in conservatively treated patients. J Neurosurg 101: 25-30, 2004 3) Inamasu J, Miyatake S, Tomioka H, et al : Subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest: a prospective computed tomography study. Resuscitation 80: 977-980, 2009 17) Wartenberg KE, Schmidt JM, Claassen J, et al : Impact of medical complications on outcome after subarachnoid hemorrhage. Crit Care Med 34: 617-623; quiz 624, 2006 16) Vergouwen MD, Fang J, Casaubon LK, et al : Higher incidence of in-hospital complications in patients with clipped versus coiled ruptured intracranial aneurysms. Stroke 42: 3093-3098, 2011 6) Inamasu J, Sadato A, Oheda M, et al : Improvement in patient outcomes following endovascular treatment of WFNS grade V subarachnoid haemorrhage from 2000 to 2014. J Clin Neurosci 27: 114-118, 2016 8) Kürkciyan I, Meron G, Sterz F, et al : Spontaneous subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest. Resuscitation 51: 27-32, 2001 10) Mitsuma W, Ito M, Kodama M, et al : Clinical and cardiac features of patients with subarachnoid haemorrhage presenting with out-of-hospital cardiac arrest. Resuscitation 82: 1294-1297, 2011 18) Wostrack M, Sandow N, Vajkoczy P, et al : Subarachnoid haemorrhage WFNS grade V: is maximal treatment worthwhile? Acta Neurochirur （Wien） 155: 579-586, 2013 4) Inamasu J, Nakae S, Ohmi T, et al : The outcomes of early aneurysm repair in World Federation of Neurosurgical Societies grade V subarachnoid haemorrhage patients with emphasis on those presenting with a Glasgow Coma Scale score of 3. J Clin Neurosci 33: 142-147, 2016 14) Schuss P, Hadjiathanasiou A, Borger V, et al : Poor-Grade Aneurysmal Subarachnoid Hemorrhage: Factors Influencing Functional Outcome─A Single-Center Series. World Neurosurg 85: 125-129, 2016 1) Arnaout M, Mongardon N, Deye N, et al : Out-of-hospital cardiac arrest from brain cause: epidemiology, clinical features, and outcome in a multicenter cohort＊. Crit Care Med 43: 453-460, 2015. 11) Mocco J, Ransom ER, Komotar RJ, et al : Preoperative prediction of long-term outcome in poor-grade aneurysmal subarachnoid hemorrhage. Neurosurgery 59: 529-538; discussion 529-538, 2006 2) Bailes JE, Spetzler RF, Hadley MN, et al : Management morbidity and mortality of poor-grade aneurysm patients. J Neurosurg 72: 559-566, 1990. 9) Lee JM, Kim TS, Joo SP, et al : Endovascular treatment of ruptured dissecting vertebral artery aneurysms─long-term follow-up results, benefits of early embolization, and predictors of outcome. Acta Neurochi （Wien） 152: 1455-1465, 2010 5) Inamasu J, Nakagawa Y, Kuramae T, et al : Subarachnoid hemorrhage causing cardiopulmonary arrest: resuscitation profiles and outcomes. Neurol Med Chir （Tokyo） 51: 619-623 2011. 7) Komiyama M, Fu Y, Yagura H, et al : Fatal aneurysmal rupture: a survey of 60 grade-5 cases. Acta Neurochir （Wien） 106: 127-131, 1990 12) Nowak G, Schwachenwald R, Arnold H : Early management in poor grade aneurysm patients. Acta neurochir （Wien） 126: 33-37, 1994 13) Randhawa VK, Nagpal AD, Lavi S : Out-of-Hospital Cardiac Arrest and Acute Coronary Syndromes: Reviewing Post-Resuscitation Care Strategies. Can J Cardiol 31: 1477-1480, 2015 15) Toussaint LG 3rd, Friedman JA, Wijdicks EF, et al : Survival of cardiac arrest after aneurysmal subarachnoid hemorrhage. Neurosurgery 57: 25-31; discussion 25-31, 2005 |
| References_xml | – reference: 11) Mocco J, Ransom ER, Komotar RJ, et al : Preoperative prediction of long-term outcome in poor-grade aneurysmal subarachnoid hemorrhage. Neurosurgery 59: 529-538; discussion 529-538, 2006 – reference: 10) Mitsuma W, Ito M, Kodama M, et al : Clinical and cardiac features of patients with subarachnoid haemorrhage presenting with out-of-hospital cardiac arrest. Resuscitation 82: 1294-1297, 2011 – reference: 5) Inamasu J, Nakagawa Y, Kuramae T, et al : Subarachnoid hemorrhage causing cardiopulmonary arrest: resuscitation profiles and outcomes. Neurol Med Chir （Tokyo） 51: 619-623 2011. – reference: 7) Komiyama M, Fu Y, Yagura H, et al : Fatal aneurysmal rupture: a survey of 60 grade-5 cases. Acta Neurochir （Wien） 106: 127-131, 1990 – reference: 8) Kürkciyan I, Meron G, Sterz F, et al : Spontaneous subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest. Resuscitation 51: 27-32, 2001 – reference: 6) Inamasu J, Sadato A, Oheda M, et al : Improvement in patient outcomes following endovascular treatment of WFNS grade V subarachnoid haemorrhage from 2000 to 2014. J Clin Neurosci 27: 114-118, 2016 – reference: 15) Toussaint LG 3rd, Friedman JA, Wijdicks EF, et al : Survival of cardiac arrest after aneurysmal subarachnoid hemorrhage. Neurosurgery 57: 25-31; discussion 25-31, 2005 – reference: 19) Yamada M, Kitahara T, Kurata A, et al : Intracranial vertebral artery dissection with subarachnoid hemorrhage: clinical characteristics and outcomes in conservatively treated patients. J Neurosurg 101: 25-30, 2004 – reference: 9) Lee JM, Kim TS, Joo SP, et al : Endovascular treatment of ruptured dissecting vertebral artery aneurysms─long-term follow-up results, benefits of early embolization, and predictors of outcome. Acta Neurochi （Wien） 152: 1455-1465, 2010 – reference: 13) Randhawa VK, Nagpal AD, Lavi S : Out-of-Hospital Cardiac Arrest and Acute Coronary Syndromes: Reviewing Post-Resuscitation Care Strategies. Can J Cardiol 31: 1477-1480, 2015 – reference: 3) Inamasu J, Miyatake S, Tomioka H, et al : Subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest: a prospective computed tomography study. Resuscitation 80: 977-980, 2009 – reference: 12) Nowak G, Schwachenwald R, Arnold H : Early management in poor grade aneurysm patients. Acta neurochir （Wien） 126: 33-37, 1994 – reference: 17) Wartenberg KE, Schmidt JM, Claassen J, et al : Impact of medical complications on outcome after subarachnoid hemorrhage. Crit Care Med 34: 617-623; quiz 624, 2006 – reference: 14) Schuss P, Hadjiathanasiou A, Borger V, et al : Poor-Grade Aneurysmal Subarachnoid Hemorrhage: Factors Influencing Functional Outcome─A Single-Center Series. World Neurosurg 85: 125-129, 2016 – reference: 1) Arnaout M, Mongardon N, Deye N, et al : Out-of-hospital cardiac arrest from brain cause: epidemiology, clinical features, and outcome in a multicenter cohort＊. Crit Care Med 43: 453-460, 2015. – reference: 16) Vergouwen MD, Fang J, Casaubon LK, et al : Higher incidence of in-hospital complications in patients with clipped versus coiled ruptured intracranial aneurysms. Stroke 42: 3093-3098, 2011 – reference: 18) Wostrack M, Sandow N, Vajkoczy P, et al : Subarachnoid haemorrhage WFNS grade V: is maximal treatment worthwhile? Acta Neurochirur （Wien） 155: 579-586, 2013 – reference: 2) Bailes JE, Spetzler RF, Hadley MN, et al : Management morbidity and mortality of poor-grade aneurysm patients. J Neurosurg 72: 559-566, 1990. – reference: 4) Inamasu J, Nakae S, Ohmi T, et al : The outcomes of early aneurysm repair in World Federation of Neurosurgical Societies grade V subarachnoid haemorrhage patients with emphasis on those presenting with a Glasgow Coma Scale score of 3. J Clin Neurosci 33: 142-147, 2016 |
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| Snippet | 「はじめに」重症くも膜下出血は, 予後不良の疾患とされる. しかし, 近年のくも膜下出血に伴う血管攣縮の治療や周術期管理の進歩もあり, 積極的に脳動脈瘤の治... |
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| SubjectTerms | cerebral aneurysm out-of-hospital cardiac arrest poor grade prognosis subarachnoid hemorrhage |
| Title | 院外心停止症例を含めたGCS 3-4重症くも膜下出血症例の特徴とその予後 |
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