Inagawa T, Shibukawa M, Inokuchi F, Tokuda Y, Okada Y, Okada K
Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan.
J Neurosurg. 2000 Dec;93(6):967-75. doi: 10.3171/jns.2000.93.6.0967.
The purpose of this study was to assess the overall management and surgical outcome of primary intracerebral hemorrhage (ICH) and aneurysmal subarachnoid hemorrhage (SAH) among the 85,000 residents of Izumo City, Japan.
During 1991 through 1996, 267 patients with ICH and 123 with SAH were treated in Izumo. Of the 267 patients with ICH, 25 underwent hematoma removal by open craniotomy or suboccipital craniectomy and 34 underwent stereotactic evacuation of the hematoma, whereas aneurysm clipping was performed in 71 of the 123 patients with SAH; operability rates were thus 22% for ICH and 58% for SAH (p < 0.0001). The overall 30-day survival rates were 86% for ICH and 66% for SAH (p < 0.0001) and the 2-year survival rates were 73% and 62% (p = 0.0207), respectively. In patients who underwent surgery, 30-day and 2-year survival rates were 93% for ICH and 100% for SAH (p = 0.0262), and 75% for ICH and 97% for SAH (p = 0.0002), respectively. In patients with ICH, the most important predictors of 30-day case-fatality rates were the volume of the hematoma, the Glasgow Coma Scale (GCS) score, rebleeding, and midline shifting, whereas those for 2-year survival were the GCS score, age, rebleeding, and hematoma volume. In patients with SAH, the most important determinants of 30-day case-fatality rates were the GCS score and age, whereas only the GCS score had a significant impact on 2-year survival.
The overall survival rates for patients with ICH or SAH in Izumo were more favorable than those in previously published epidemiological studies. However, despite improved surgical results, the overall management of ICH and SAH still produced an unsatisfactory outcome, mainly because of primary brain damage.
本研究旨在评估日本出云市85000名居民中原发性脑出血（ICH）和动脉瘤性蛛网膜下腔出血（SAH）的整体管理情况及手术结果。
在1991年至1996年期间，出云市共治疗了267例ICH患者和123例SAH患者。在267例ICH患者中，25例行开颅血肿清除术或枕下颅骨切除术，34例行立体定向血肿清除术；而在123例SAH患者中，71例行动脉瘤夹闭术；因此，ICH的可手术率为22%，SAH为58%（p<0.0001）。ICH的30天总生存率为86%，SAH为66%（p<0.0001），2年生存率分别为73%和62%（p=0.0207）。接受手术的患者中，ICH的30天和2年生存率分别为93%和75%，SAH分别为100%和97%（p=0.0262和p=0.0002）。在ICH患者中，30天病死率的最重要预测因素是血肿体积、格拉斯哥昏迷量表（GCS）评分、再出血和中线移位，而2年生存率的预测因素是GCS评分、年龄、再出血和血肿体积。在SAH患者中，30天病死率的最重要决定因素是GCS评分和年龄，而只有GCS评分对2年生存率有显著影响。
出云市ICH或SAH患者的总体生存率比先前发表的流行病学研究中的生存率更有利。然而，尽管手术结果有所改善，但ICH和SAH的整体管理仍产生了不尽人意的结果，主要原因是原发性脑损伤。
