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Neurological Surgery No Shinkei Geka Volume 35, Issue 8 （August 2007）

Neurological Surgery 脳神経外科 35巻8号（2007年8月発行）

Japanese English

研究

シャント術が有効であった特発性正常圧水頭症における術後症状改善パターンと家族満足度の長期追跡調査 Postoperative Patterns of Improvement of Symptoms and Degrees of Satisfaction in Families of Patients after Operations for Definite Idiopathic Normal Pressure Hydrocephalus: A Long-term Follow-up Study 竹内東太郎 ¹ , 後藤博美 ² , 伊崎堅志 ² , 田村晋也 ² , 笹沼仁一 ² , 前野和重 ² , 菊池泰裕 ² , 冨井雅人 ² , 小泉仁一 ² , 渡辺善一郎 ² , 沼澤真一 ² , 伊藤康信 ² , 大原宏夫 ² , 古和田正悦 ² , 渡邊一夫 ² Totaro TAKEUCHI ¹ , Hiromi GOTO ² , Kenji IZAKI ² , Shinya TAMURA ² , Zinichi SASANUMA ² , Kazushige MAENO ² , Yasuhiro KIKUCHI ² , Masato TOMII ² , Zinichi KOIZUMI ² , Zenichiro WATANABE ² , Shinichi NUMAZAWA ² , Yasunobu ITO ² , Hiroo OHARA ² , Masayoshi KOWADA ² , Kazuo WATANABE ² ¹壮幸会行田総合病院脳神経外科 ²脳神経疾患研究所附属総合南東北病院脳神経外科 ¹Department of Neurosurgery, The Gyoda General Hospital ²Department of Neurosurgery, The Southern TOHOKU General Hospital キーワード： normal pressure hydrocephalus , V-P shunt , L-P shunt , mini mental state examination (MMSE) , outcome Keyword: normal pressure hydrocephalus , V-P shunt , L-P shunt , mini mental state examination (MMSE) , outcome pp.773-779

発行日 2007年8月10日 Published Date 2007/8/10

DOI https://doi.org/10.11477/mf.1436100591

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　特発性正常圧水頭症（idiopathic normal pressure hydrocephalus：iNPH）では歩行障害（gait disturbance：G）や尿失禁（urinary incontinence：U）は治療後比較的早期より改善が認められるが，認知症（dementia：D）は徐々に改善する傾向があると言われている^5,12)．しかしiNPHはGが主徴であることが多いため^1,4,9,11,15)，医療従事者はGが改善すると治療効果に満足し，患者を介護している家族も同様であると判断することが考えられる．

　今回筆者らは，治療後有効と判定されたdefinite iNPHにおける治療後1年間の追跡調査を実施して，特に家族および医療従事者の満足度の継時的推移を比較検討し，同時にGとDの定量的測定によって継時的な症状改善パターンの再評価を行ったので報告する．

　Purpose To clarify the patterns of improvement of pre-and post-operative symptoms and family satisfaction in patients with definite idiopathic normal pressure hydrocephalus (iNPN) who responded well to shunt intervention.

　Subjects and methods The subjects included 40 patients definitively diagnosed with iNPH and who were followed up for one year or longer (age, 61-85; male-to-female ratio, 18: 22). The study focused on (1) preoperative clinical symptoms, (2) improvements in symptoms at 1, 3, 5, and 12 months after surgery, and the satisfaction of the families based on medical results of the Zarit caregiver burden interview, and infomation through questionnaires to medical personnel.

　Results (1) The major symptoms were gait disturbance (G, n=38), dementia (D, n=10), and urinary incontinence (U, n=23). G and D appeared as initial symptoms in 30 and 10 cases, respectively. (2) The rates of postoperative improvement at 1, 3, 5, and 12 months were 94.7%, 94.7%, 97.4%, and 94.7% for G, 43.8%, 62.5%, 71.9%, and 84.4% for D, and 78.3%, 86.96%, 86.96%, and 91.3% for U, respectively. G and U cases improved during the postoperative early stage, and D improved gradually from after the third postoperative month. The family satisfaction before surgery and at 1, 3, 5, and 12 months after surgery was 72.5±12.8, 68.1±15.4, 55.7±9.6, 52.9±11.4, and 47.3±7.9 points, respectively. The rate of improvement in satisfaction was higher for D. The satisfaction of the medical personnel was 88 percent (+) at 1 month and tended to remain high for 12 months.

　Conclusion (1) Preoperative gait disturbance is a major initial symptom in definitively diagnosed iNPN. (2) Postoperative improvement of G and U is obtained at an early stage. In contrast, D tends to improve gradually from after the third postoperative month. The family satisfaction increases as the symptom of D improve. The satisfaction of the medical personnel tends to remain high after the first postoperative month. This study investigated the results of quantitative analyses of the patients' symptoms.