雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 21, Issue 9 （September 1993）

Neurological Surgery 脳神経外科 21巻9号（1993年9月発行）

Japanese English

研究

くも膜下出血における急死の原因の検討 The Etiology of Sudden Deth in Subarachnoid Hemorrhage 北原孝雄 ¹ , 増田卓 ¹ , 相馬一亥 ¹ Takao KITAHARA ¹ , Takashi MASUDA ¹ , Kazui SOMA ¹ ¹北里大学救命救急医学 ¹Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine キーワード： Subarachnoid hemorrhage , Dead on arrival（DOA） , Sudden death , Cardiac arrhythmia , Contraction band necrosis Keyword: Subarachnoid hemorrhage , Dead on arrival（DOA） , Sudden death , Cardiac arrhythmia , Contraction band necrosis pp.781-786

発行日 1993年9月10日 Published Date 1993/9/10

DOI https://doi.org/10.11477/mf.1436900698

PDF(5393KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

I．はじめに

　破裂脳動脈瘤によるくも膜下出血（SAH）の中に急死例が存在することは以前から知られている^{5,11,20,27）}．また，発症後病院にも到達しえず死亡するものはSAH患者の15％にも及ぶとされ^2），このように発症後超早期に死亡するに至る臨床経過は，高血圧性脳内出血や脳梗塞などSAH以外の脳血管障害ではほとんどみられず^16，23），SAHに極めて特徴的である，しかしながら，このようなSAHの急死の病態や急死の機序に関するまとまった報告はみられない．

　本稿では発症後ただちに心肺停止状態が確認されたSAH例を分析し，急死の病態，機序につき検討を加えた．

Sudden death due to subarachnoid hemorrhage (SAH) is not uncommon. However, the mechanism remains un-clear. In this paper, sixty-eight consecutive patients with sudden death in SAH (DOA group) were studied to clar-ify the etiology of sudden cardiopulmonary arrest (CPA) in SAH. SAH was confirmed by CT scan and/or by autopsy. These patients accounted for 10% of the total intrinsic DOA patients in that period. Clinical symptoms, CT scan and autopsy findings concerning the DOA group were carefully evaluated and compared to those of patients with SAH of WFNS Grade V (V group). The DOA group accounted for 10% of all SAH pa-tients. Average time interval from the onset of SAH to the recognition of CPA was 21.2 minutes. In 30% of cases, the time interval was within 15 minutes. Pulmo-nary edema was recognized as being significantly higher in the DOA group than in the V group (P＜ 0.01). In CT finding, the number of patients who were classified into S type (mainly subarachnoid clot only) was significantly higher in the DOA group than in the V group (P＜ 0.01). The CT Score and MAX. CT NO. in the DOA group were significantly lower than in the V group (P ＜ 0.01 and P ＜ 0.0001, respectively), suggesting that the intensi-ty of subarachnoid hemorrhage was not severe in the DOA group. Postmortem histological examination of the myocardium was carried Out on 6 cases of the DOA group. A contraction band necrosis in the myocardium which did not correspond to the coronary perfusion area was found in all 6 patients. The possible mechanisms re-sponsible for SAH-triggered CPA was discussed. Fatal arrhythmia associated with SAH is suggested to be one of the most important causes of sudden CPA in SAH.