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Neurological Surgery No Shinkei Geka Volume 42, Issue 6 （June 2014）

Neurological Surgery 脳神経外科 42巻6号（2014年6月発行）

Japanese English

研究

離島発症くも膜下出血患者のヘリコプター搬送のタイミングについて Timing of Helicopter Transportation for Patients Presenting with Subarachnoid Hemorrhage on Isolated Islands 川原一郎 ¹ , 松永裕希 ¹ , 堤圭介 ¹ , 高畠英昭 ¹ , 小野智憲 ¹ , 戸田啓介 ¹ , 馬場啓至 ¹ Ichiro KAWAHARA ¹ , Yuki MATSUNAGA ¹ , Keisuke TSUTSUMI ¹ , Hideaki TAKAHATA ¹ , Tomonori ONO ¹ , Keisuke TODA ¹ , Hiroshi BABA ¹ ¹国立病院機構長崎医療センター脳神経外科 ¹Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center キーワード： helicopter transportation , isolated islands , re-rupture , subarachnoid hemorrhage Keyword: helicopter transportation , isolated islands , re-rupture , subarachnoid hemorrhage pp.537-543

発行日 2014年6月10日 Published Date 2014/6/10

DOI https://doi.org/10.11477/mf.1436102262

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参考文献 Reference

Ⅰ．はじめに

　くも膜下出血（subarachnoid hemorrhage：SAH）患者における脳動脈瘤の再破裂は，状態悪化とともに予後不良へと導く重篤な事態である．再破裂時期に関しては種々の報告があるが，一般的には初回発症から6時間以内が最も再破裂を来しやすいと言われており^5,14,15)，その間の厳重な急性期管理が要求され，現在では一定のconsensusが得られている．再破裂をいかに予防し脳卒中専門医のいる病院へ搬送するかは重要で，通常SAH患者は救急車にて搬送されてくる．一方，離島発症のSAH患者の場合，その搬送は通常ヘリコプター（ヘリ）が主体である．しかしながら，報告例^2,3,7,11)が極めて少ないこともあり，SAH発症後の最も安全かつ有効なヘリ搬送のタイミングに関しては定まった見解はない．われわれも搬送中の再破裂を極力回避するため発症後間もない症例などは暗黙的に6時間経過した後に搬送する傾向があったが，これらの適否について再検証を行い，長年離島医療支援を担ってきた経験をもとに現状での問題点を踏まえ報告する．

　Cerebral aneurysm re-rupture following subarachnoid hemorrhage（SAH）is a serious problem that is related with poor outcome. It is generally said that re-rupture occurs within 6 hours of the initial SAH;in the acute stage, strict management is needed even in the period before hospitalization. The aim of this study was to confirm whether patients on isolated islands should be transferred by helicopter ＞ 6 hours after the initial SAH. Here we reviewed 125 cases of SAH in the isolated islands of Nagasaki prefecture between January 2007 and December 2012 who were transferred to Nagasaki Medical Center by helicopter as a result of consultation via TeleStroke（41 men, 84 women;mean age, 65.76 years). Re-rupture was observed in seven patients（5.6%), five of whom were diagnosed with re-rupture in a prior hospital on the isolated island. No patients demonstrated clinical deterioration during transport.

　Early helicopter transportation under adequate sedation and control of blood pressure within 6 hours is safe, and patients should be transferred as quickly as possible during the day. On the other hand, at night, flight safety must first be considered. Patients in stable clinical condition may be transferred the next day. We should pay special attention to patients with SAH and intracerebral hemorrhage, severe SAH, or vertebral artery dissecting aneurysm because their condition may gradually become more serious even if initially stable.