脳卒中治療の中・長期予後 高齢者脳動脈りゅう手術症例の長期予後 健康寿命の視点から

Abstract

We analyzed the surgical results of patients in their 70s suffering from ruptured aneurysms to clarify the possible factors related to poor outcomes. We also investigated the active life expectancy for patients with good recovery on discharge.Over a period of 21 years (1978-1998), we surgically treated 144 patients with ruptured aneurysms who were 70 years of age or older. Seventy-nine patients (54.9%) obtained a good recovery, 45 (31.3%) were in a disabled condition, and 20 (13.8%) died. The main reason for disability and death was assessed retrospectively. Moreover, we conducted a follow-up study, including interviews, to determine survival rate, quality of life, active life expectancy, incidence of ADL disability and duration of ADL disability for patients with good recovery on discharge.Factors of poor outcome for patients in their 70s with ruptured aneurysms were aging itself, a poor grade of SAH, and the aneurysm location (especially distal ACA). Misdiagnoses, operative troubles, postoperative cerebral hemorrhage and infarction were other factors influencing poor outcomes.For patients having a good recovery on discharge, independence with meaningful activity can extend to 6 years after discharge. The overall incidence of ADL disability for patients in their 70s was 2.4 times higher than that of aged people in Sendai City; however, the duration of ADL disability was shorter than that reported in the Japan control study.