離島で発症し急性期にヘリコプター搬送を受けたくも膜下出血患者の転帰  [in Japanese] Outcome of Island Patients Who Received Emergency Helicopter Transport for Taeatment of Subarachnoid Hemorrhage  [in Japanese]

長崎県離島(対馬,壱岐,五島)には脳神経外科手術施設が存在しないため,脳神経外科的治療を要する患者が発生した場合,以前からヘリコプター搬送が利用されており,その大部分が国立病院長崎医療センター脳神経外科に運ばれ治療を受けてきた.近年,その件数は年間約90例となっている.くも膜下出血(SAH)患者も,急性期に当院に搬送されているが,ヘリコプター搬送中,患者は騒音,振動,気温変化,気圧変化などの再破裂の危険に曝されると考えられる.また機内で医師が行いうる医療行為には制限があることも事実である.以上のことから,救急車により搬送される内地発症SAH症例に比較し,離島発症例には予後不良となる要因がより多く存在する可能性がある.そこで,当施設にて治療を受けたSAH症例を離島発症群,内地発症群に分け転帰を比較してみた.

To determine the risk and benefit, of emergency helicopter transport of island patients for treatment of subarachnoid hemorrhage (SAH), we retrospectively analyzed 96 consecutive patients with SAH treated in our institution over the last 2 years. The island group consisted of 55 island patients who received emergency helicopter transport, the mean distance and duration of which were 140 km and 40 minutes, respectively. The land group consisted of 41 land patients transported by ambulance. Only one rerupture during flight was confirmed among the island group. Age, sex, and the time interval between onset and admission did not significantly differ between the 2 groups. At admission, there were 3 patients with Hunt &Kosnik (H &K) Grade 5 in the island group, and 7 with H &K Grade 5 in the land group, and the poor-grade patients were fewer in t,he former (p = 0.09). Fifty-two of 55 patients in the island group, and 29 of 41 patients in the land group were treated operatively or interventionally, and 2 of the former and 12 of the latter were conservatively treated mainly because of poor grade, which was significantly different (p = 0.003). At discharge, the number of patients with modified Rankin Scale Grade 0, 1, and 2 were 27 in the island group, and 12 in the land group, and the outcome of patients in the former tended to be better (p = 0.09). The emergency helicopter medical transport of the patients with SAH was thought, to be safe and effective.