Inagawa T, Tokuda Y, Ohbayashi N, Takaya M, Moritake K
Department of Neurosurgery, Shimane Prefectural Central Hospital, Japan.
Stroke. 1995 May;26(5):761-6. doi: 10.1161/01.str.26.5.761.
Estimation of the actual incidence rate of subarachnoid hemorrhage and evaluation of the treatment require the inclusion of all patients in a defined geographic area.
During 1987 through 1992 in Izumo City, Japan, we estimated the incidence rate of subarachnoid hemorrhage by including dead-on-arrival patients and by further adding the results obtained after reviewing all death certificates registered in this city in the corresponding period. In addition, we compared the management and surgical outcomes in hospitalized patients from 1987 through 1992 with outcomes from 1980 through 1986.
During 1987 through 1992, we diagnosed 123 patients as having subarachnoid hemorrhage. The crude and the age- and sex-adjusted incidence rates using the 1990 population statistics for Japan were 25 (95% confidence interval, 21 to 30) per 100,000/y and 23 (95% confidence interval, 19 to 28) per 100,000/y for all ages, respectively; these occurrences are the highest among those reported to date. Of these patients, 8% died before receiving medical attention, 27% in the first week, and 39% at 1 month. The survival curve for 2 years improved significantly from 1980-1986 to 1987-1992 in patients with admission grades 4 and 5 (P = .035) and in operated patients with preoperative grades 1 through 3 (P = .036). However, there was little improvement in the overall management results (P = .168), possibly because patients with high risk and/or old age were admitted and/or diagnosed more often in the latter period.
The incidence rate of subarachnoid hemorrhage is much higher than that reported so far in the literature, and despite improvement of management and surgical therapy, the actual case-fatality rate is still high, mainly because of the high mortality rate directly associated with the primary bleeding.
要估算蛛网膜下腔出血的实际发病率并评估治疗效果，就需要纳入特定地理区域内的所有患者。
1987年至1992年期间，在日本出云市，我们通过纳入入院时已死亡的患者，并进一步汇总审查该市同期登记的所有死亡证明后得出的结果，来估算蛛网膜下腔出血的发病率。此外，我们比较了1987年至1992年住院患者的治疗管理及手术结果与1980年至1986年的结果。
1987年至1992年期间，我们诊断出123例蛛网膜下腔出血患者。按照1990年日本人口统计数据计算，所有年龄段的粗发病率以及年龄和性别调整后的发病率分别为每10万人年25例（95%置信区间为21至30例）和每10万人年23例（95%置信区间为19至28例）；这些发病率是迄今报告的发病率中最高的。在这些患者中，8%在接受医疗救治前死亡，27%在第一周内死亡，39%在1个月时死亡。4级和5级入院患者以及术前1至3级的手术患者，其2年生存曲线从1980 - 1986年到1987 - 1992年有显著改善（P = 0.035）。然而，总体治疗管理结果几乎没有改善（P = 0.168），这可能是因为后期高风险和/或老年患者入院和/或被诊断出的情况更频繁。
蛛网膜下腔出血的发病率远高于迄今文献报道的发病率，尽管治疗管理和手术治疗有所改善，但实际病死率仍然很高，主要原因是与原发性出血直接相关的高死亡率。
