15. Ikawa F, Ohbayashi N, Imada Y, Matsushige T,
Kajihara Y, Inagawa T, et al. : Analysis of subarachnoid
１. 厚生労働省：平成30年（2018年）人口動態統計月報年
hemorrhage according to the Japanese Standard Stroke
計（概数）．東京；Press Release，2018
Registry Study -incidence, outcome, and comparison
２. 厚生労働省：平成28年国民生活基礎調査の概要．東
with the International Subarachnoid Aneurysm Trial- .
京；Press Release，2016
３. 小林祥泰，大櫛陽一：脳卒中データバンク2009．東
京；中山書店，2009：22-23
Neurol Med Chir（Tokyo）2004; 44: 275-276
16. Nieuwkamp DJ, de Gans K, Rinkel GJ, Algra A:
Treatment and outcome of severe intraventricular
４. Suzuki K, Kutsuzawa T, Takita K, Ito M, Sakamoto
extension in patients with subarachnoid or
T, Hirayama A, et al. : Clinico-epidemiologic study of
intracerebral hemorrhage: a systematic review of the
stroke in Akita, Japan. Stroke 1987; 18: 402-406
５. Kita Y, Okayama A, Ueshima H, Wada M, Nozaki
A, Choudhury SR, et al. : Stroke incidence and case
literature. J Neurol 2000; 247
（2）
: 117-121
17. de Rooij NK, Linn FH, van der Plas JA, Algra A,
fatality in Shiga, Japan 1989-1993. Int J Epidemiol 1999;
28（6）:1059-1065
６. Kita Y, Turin TC, Ichikawa M, Sugihara H, Morita
－35－
Rinkel GJ: Incidence of subarachnoid haemorrhage:
a systematic review with emphasis on region, age,
gender and time trends. J Neurol Neurosurg Psychiatry
渡辺，小久保，近藤，嘉山，園田
2007; 78（12）:1365-1372
Release，2010
18. Sudlow CL1, Warlow CP: Comparable studies of the
27. 厚 生 労 働 省： 第21回 生 命 表（完 全 生 命 表 ）
． 東 京；
incidence of stroke and its pathological types: results
from an international collaboration. International Stroke
Press Release，2010
28. Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S,
Incidence Collaboration. Stroke 1997; 28（3）:491-499
Hashimoto N, et al. : The natural course of unruptured
19. 山城重雄，吉田顯正，等泰之，倉津純一：地方都市
cerebral aneurysms in a Japanese cohort. UCAS Japan
におけるくも膜下出血の治療成績の変化－単独施設に
おける20年間587例の解析結果から－．脳卒中の外科 Investigators. N Engl J Med 2012; 366
（26）
: 2474-2482
29. 鐙谷武雄，七戸秀夫，黒田敏，石川達哉，岩崎喜信，
2011；39：406-412
小林祥泰：脳卒中データバンクを利用したくも膜下出血
20. 上之郷眞木雄，鳥羽保，牛島隆二郎，林之茂，米倉正
の解析－発症年齢，性差，予後における全国・地域別の
大，永田泉：くも膜下出血の予後は改善したか？－長期
間長崎県悉皆調査データの解析結果から－．脳卒中の外
検討－．脳卒中の外科 2006；34
（1）
：49-53
30. Lovelock CE, Rinkel GJ, Rothwell PM: Time trends
科 2012；40：229-232
in outcome of subarachnoid hemorrhage: Population-
21. 近藤礼，松森保彦，加藤直樹，土谷大輔，小久保安
昭，佐藤慎哉，他：山形県における脳卒中の実態－５年
間の全県脳卒中登録の結果から．脳と神経 2006；58
based study and systematic review. Neurology 2010; 74
（19）
: 1494-1501
31. Nieuwkamp DJ, Setz LE, Algra A, Linn FH, de Rooij
（3）
：213-218
NK, Rinkel GJ: Changes in case fatality of aneurysmal
22. 太田富雄，和賀志郎，半田肇，斉藤勇，馬杉則彦，竹
subarachnoid haemorrhage over time, according to age,
内一夫，他：急性期意識障害の新しいgradingとその表
現法：いわゆる３-３-９度方式．脳卒中の外科研究会講
演集 1975；3（0）：61-68
sex, and region: a meta-analysis. Lancet Neurol 2009; 8
（7）
: 635-642
32. Connolly ES Jr, Rabinstein AA, Carhuapoma JR,
23. Hunt WE, Hess RM: Surgical risk as related to time
Derdeyn CP, Dion J, Higashida RT, et al. : American
of intervention in the repair of intracranial aneurysms.
Heart Association Stroke Council; Council on
J Neurosurg 1968; 28: 14-20
Cardiovascular Radiology and Intervention; Council
24. Hunt WE, Kosnik EJ: Timing and perioperative care
on Cardiovascular Nursing; Council on Cardiovascular
in intracranial aneurysm surgery. Clin Neurosurg 1974;
Surgery and Anesthesia; Council on Clinical Cardiology:
21: 79-89
Guidelines for the management of aneurysmal
25. Yamada Y, Kokubo Y, Kondo R, Sato S, Kato T,
subarachnoid hemorrhage: a guideline for healthcare
Kubota I, et al. : The trends in cerebral infarction in
professionals from the American Heart Association/
Yamagata Prefecture, Japan－A study based on 10
american Stroke Association. Stroke 2012; 43
（6）
: 1711-
years of stroke registry data－. Yamagata Med J 2018;
36（2）:128-138
1737
33. 鈴木倫保：くも膜下出血治療に残された課題．脳神経
26. 総 務 省 統 計 局： 平 成22年 国 勢 調 査． 東 京；Press
－36－
外科ジャーナル 2013；10：759-769
Yamagata Med J（ISSN 0288-030X）2020；38
15年間の山形県脳卒中登録データからの検討
（1）
：25-37
DOI 00.00000/00000000
DOI 10.15022/00004780
Actual condition of subarachnoid hemorrhage
with ruptured cerebral aneurysm in Yamagata prefecture
Shigeki Watanabe＊， Yasuaki Kokubo＊， Rei Kondo＊＊，
Takamasa Kayama＊＊＊， Yukihiko Sonoda＊
Department of Neurosurgery, Yamagata University Faculty of Medicine
＊＊
Department of Neurosurgery, Yamagata City Hospital Saiseikan
＊＊＊
Department of Advanced Medicine, Yamagata University Faculty of Medicine
ABSTRACT
Background: Subarachnoid hemorrhage（SAH）due to ruptured cerebral aneurysms is still
associated with a high mortality rate. We investigated the actual condition of SAH to clarify the
factors associated with a poor prognosis based on the data on strokes registered in the Yamagata
Society on Treatment for Cerebral Stroke over the past 15 years.
Subjects and Methods: The subjects included 4460 patients（1460 men）with SAH who were
registered from 1998; the average age was 66.0±14.5 years. The whole period was divided into the
early（1998-2002）
, middle（2003-2007）
, and late（2008-2012）phases. The mean age at onset in the
early phase（64.9±13.6）was significantly older in comparison to the middle（66.3±14.9）and late（66.9
±15.0）phases.
Results: The comparison of the outcomes between clipping and endovascular treatment indicated
that the latter treatment was associated with better outcomes in elderly patients, especially those
over 80 years of age. According to a multiple logistic regression analysis, the severity at the onset
and older age were significantly associated with a poor prognosis.
Conclusions: To improve the outcomes of treatment for SAH, indications should be considered and
the treatment strategy should be carefully selected, especially for elderly patients.
Keywords: subarachnoid hemorrhage, cerebral aneurysm, clipping, coil embolization, aged society
－37－
...
論文の公開元へ
