急性期破裂脳動脈瘤の治療成績

―Stroke Care Unit開設前後での比較検討―

抄録

Patients with aneurysmal subarachnoid hemorrhage (SAH) may experience re-rupture, vasospasm, or systemic complications, which were the major cause of poor outcome. Thus, critical management in the stroke care unit (SCU) with meticulous monitoring and close neurologic observation is vital. We started neurosurgical services in April 2000, and an SCU was established in June 2003. We clinically evaluated 74 consecutive patients with SAH between April 2000 and June 2005, which were divided into 2 groups, non-SCU and SCU groups, before and after the establishment of the SCU. The non-SCU group had 37 patients and the SCU group had 37 patients. Clinical outcomes were assessed with modified Rankin scale and Glasgow outcome scale at 3-month follow-up. Statistical analysis demonstrated that the frequency rates of re-rupture before clipping and neurological worsening caused by vasospasm were remarkably reduced. The re-rupture rates before clipping were 27.0% for non-SCU patients vs. 2.7% for SCU patients (p=0.0033). The rates of neurological worsening caused by vasospasm were 39.1% for non-SCU patients vs. 6.1% for SCU patients (p=0.0022). The rates of good recovery were 16.2% for non-SCU patients vs. 70.3% for SCU patients (p<0.0001). The death rate for non-SCU patients was 40.5% vs. 18.9% for SCU patients (p=0.042).
Thorough management in SCU with expert nursing enabled a markedly reduced rate of re-rupture and vasospasm, significantly improving the outcome of patients with SAH.