急性期リハビリテーションの立場から見た脳動脈瘤破裂によるくも膜下出血患者の短期ADL帰結の予測  [in Japanese] Early Prediction of Short-term Outcome of Activities of Daily Living after Ruptured Aneurysmal Subarachnoid Hemorrhage  [in Japanese]

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Author(s)

    • 高橋 友哉 TAKAHASHI Tomoya
    • 金沢大学医学部附属病院リハビリテーション部 Division of Rehabilitation Medicine, Kanazawa University Hospital
    • 染矢 富士子 [他] SOMEYA Fujiko
    • 金沢大学大学院医学系研究科リハビリテーション科学領域 School of Rehabilitation Science, Faculty of Medicine, Kanazawa University
    • 立野 勝彦 TACHINO Katsuhiko
    • 金沢大学大学院医学系研究科リハビリテーション科学領域 School of Rehabilitation Science, Faculty of Medicine, Kanazawa University

Abstract

金沢大学医薬保健研究域保健学系本研究は脳動脈瘤破裂によるくも膜下出血(SAH)の急性期加療中における短期ADL帰結予測を目的とし,SAH発症2〜4週における意識レベル,頭部CT所見,運動障害の程度,尿便意に対し予測因子の有効性を分析した.対象は,SAHの診断で脳神経外科的初期治療をうけ,脳血管攣縮等の時期を乗り切った後に経過が安定していた150例である.予測事項は次のI群ないしII群とした.I群;発症3カ月時のバーセル指数≧85点.II群;発症3カ月時のバーセル指数≦80点.I群の有効な予測因子は「発症4週以内に尿便意正常化」であり,II群は「発症4週で重度の運動障害」であった.「発症2週でJCS3桁」「発症4週でJCS20〜30もしくはapallic」は予測因子としては低感度だがII群予測に特異的な因子と考えられた.本研究結果は,急性期加療中のSAH患者に対する回復期以降のリハビリテーション方針を論議するのに有用と考える. The purpose of this study was to determine the factors involved in predicting dependence or independence in activities of daily living (ADL) over a three-month period after the onset of ruptured aneurysmal subarachnoid hemorrhage (SAH). One hundred and fifty cases with a mean age of 60.6±11.1 years, who had been admitted to the neurosurgical unit at Kanazawa University Hospital from 1989 to 2003, were investigated. ADL at three months were scored with the Barthel Index (BI). The independent group with a BI≧85 comprised 103 cases, and the dependent group with a BI≦80 comprised 47 cases. The following were analyzed in terms of predictive value, false positive rate and sensitivity: Japan Coma Scale scores (JCS) at 2 and 4 weeks, computed tomographic (CT) findings at 4 weeks, severity of motor impairment at 4 weeks and notification of voiding at 4 weeks. Normal notification of voiding at 4 weeks was a valid predictor for the independent group (97% in terms of predictive value, with false positive rate and sensitivity scoring 4% and 69%, respectively). By contrast, moderate to severe motor impairment at 4 weeks was valid for the dependent group (97%, 1% and 68%). Though sensitivities were low, the JCS 100-300 at 2 weeks (100%, 0% and 19%) and the JCS 20, 30 a/o apallic state at 4 weeks (100%, 0% and 32%) were estimated to be specific predictors for the dependent group. These results may help in discussions at a relatively early stage of SAH regarding appropriate patient-specific rehabilitation strategies to be followed after discharge to acute phase inpatient units.

The purpose of this study was to determine the factors involved in predicting dependence or independence in activities of daily living (ADL) over a three-month period after the onset of ruptured aneurysmal subarachnoid hemorrhage (SAH). One hundred and fifty cases with a mean age of 60.6±11.1 years, who had been admitted to the neurosurgical unit at Kanazawa University Hospital from 1989 to 2003, were investigated. ADL at three months were scored with the Barthel Index (BI). The independent group with a BI≧85 comprised 103 cases, and the dependent group with a BI≦80 comprised 47 cases. The following were analyzed in terms of predictive value, false positive rate and sensitivity: Japan Coma Scale scores (JCS) at 2 and 4 weeks, computed tomographic (CT) findings at 4 weeks, severity of motor impairment at 4 weeks and notification of voiding at 4 weeks. Normal notification of voiding at 4 weeks was a valid predictor for the independent group (97% in terms of predictive value, with false positive rate and sensitivity scoring 4% and 69%, respectively). By contrast, moderate to severe motor impairment at 4 weeks was valid for the dependent group (97%, 1% and 68%). Though sensitivities were low, the JCS 100-300 at 2 weeks (100%, 0% and 19%) and the JCS 20, 30 a/o apallic state at 4 weeks (100%, 0% and 32%) were estimated to be specific predictors for the dependent group. These results may help in discussions at a relatively early stage of SAH regarding appropriate patient-specific rehabilitation strategies to be followed after discharge to acute phase inpatient units.

Journal

  • The Japanese journal of rehabilitation medicine

    The Japanese journal of rehabilitation medicine 43(12), 820-827, 2006-12-18

    The Japanese Association of Rehabilitation Medicine

References:  15

Codes

  • NII Article ID (NAID)
    110005716794
  • NII NACSIS-CAT ID (NCID)
    AN00250275
  • Text Lang
    JPN
  • Article Type
    ART
  • ISSN
    18813526
  • NDL Article ID
    8615429
  • NDL Source Classification
    ZS35(科学技術--医学--外科学・整形外科学・麻酔学)
  • NDL Call No.
    Z19-283
  • Data Source
    CJP  NDL  NII-ELS  IR 
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