脳血管障害における急性初期治療開始に要する時間の検討  [in Japanese] Factors delaying CT examination, and antithrombotic therapy after onset in acute stroke  [in Japanese]

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Abstract

1年間に入院した急性期のアテローム血栓性脳梗塞28例,ラクナ梗塞57例,心原性脳塞栓25例,分類不能の脳梗塞11例,脳出血31例を対象に,初期治療までに要した時間を検討した.睡眠中発症例は25例(16.4%)あり,アテローム血栓性脳梗塞とラクナ梗塞で多かった.発症からCT撮影までの平均時間は,心原性脳塞栓症が2.06時間,脳出血が6.84時間,アテローム血栓性脳梗塞が20.78時間,ラクナ梗塞が38.69時間であった.CT撮影までに要した時間は,救急車で来院,救急外来を受診,他院受診せずに直接来院,臨床病型で心原性脳塞栓症と脳出血が有意に早かった.発症3時間以内にCT撮影が終了しているものは36例(23.7%)あり,心原性脳塞栓症が15例(60.0%),脳出血が15例(48.4%),ラクナ梗塞5例(9.1%)であった.しかし,抗血栓療法が開始されたのは発症3時間以内は1例もなく,6時間以内でもラクナ梗塞の2例と心原性脳塞栓症1例にすぎなかった.早期初期治療のためには,脳血管障害が疑われたならば救急車を呼ぶことの啓蒙と,来院後の早期治療開始の院内のシステム作りが必要と考えられた.

To assess the factors influencing the times to CT examination, and antithrombotic therapy in acute stroke, we investigated the detailed circumstances in all patients admitted to our hospital over a period of 12 months. The patients comprised 28 with atherothrombotic infarction (ATI), 57 with lacunar infarction (LI), 25 with cardiogenic embolism (CE), 11 with unclassified infarction, and 31 with intracerebral hemorrhage (ICH). Twenty-five patients (16.4%; 7 ATI, 12 LI, 3 CE, and 2 ICH) awoke with stroke symptoms. The mean time from stroke onset to CT examination was 2.06 hours in CE, 6.84 hours in ICH, 20.78 hours in ATI, and 38.69 hours in Ll. An early CT examination time was associated with emergency department arrival, ambulance call, direct arrival (no refessal to another physician), CE and ICH. The CT examination was completed within 3 hours in 36 patients (15 CE, 15 ICH, and 5 LI) from stroke onset. However, no case was started on any antithrombotic therapy within 3 hours, and only 3 patietns were within 6 hours. These findings suggest that professional education in the hospital is needed for the early assessment of stroke (CT examination) and treatment.

Journal

  • Nosotchu

    Nosotchu 20(5), 480-488, 1998-10-25

    The Japan Stroke Society

References:  16

Cited by:  2

Codes

  • NII Article ID (NAID)
    10005237679
  • NII NACSIS-CAT ID (NCID)
    AN0020186X
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    09120726
  • Data Source
    CJP  CJPref  J-STAGE 
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