重症クモ膜下出血症例におけるSOFA scoreを用いた臓器障害の検討

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Systemic organ dysfunction in patients with severe subarachnoid hemorrhage was evaluated using the SOFA score throughout the follow-up period to characterize organ dysfunction resulting from neuroendocrine reactions during the acute stage of subarachnoid hemorrhage. Of the 194 patients with subarachnoid hemorrhages resulting from a ruptured cerebral aneurysm who were admitted to our department between 1996 and 2000, 100 patients whose SOFA scores could be calculated over a follow-up period after their admission (WFNS grade IV, V: poor grade group [n=79]; WFNS grade I, II, III: non-poor grade group [n=21]) were enrolled in the study. The SOFA scores at the time of admission (day 0), after 24 hours (day 1), 48 hours (day 2), 72 hours (day 3) and 96 hours (day 4) were compared in the poor and non-poor grade groups. The SOFA score on day 0 was significantly (p<0.05) higher in the poor grade group (poor grade group, 5.89±2.040; nonpoor grade group, 1.71±0.960). The SOFA score continued to be higher in the poor grade group throught the entire observation period; the SOFA score excluding the GCS score was also significantly higher (p<0.05) in the poor grade group. The SOFA score in the poor grade group increased significantly (p<0.0001) on day 1, compared with its value on day 0, and the increase continued until day 4. The respiratory dysfunction score, determined by the P/F ratio, was slightly higher in both groups at the time of admission, compared to normal, and this increase continued until day 4, although the difference between the groups was not statistically significant. The coagulation dysfunction score, determined by the platelet count, was significantly higher (p<0.05) in the poor grade group on day 1 and day 4. The circulatory dysfunction score was significantly higher in the poor grade group from day 1 to day 4. The liver dysfunction and renal dysfunction scores did not increase significantly in either group. The possibility of organ dysfunctions, especially coagulation and circulatory dysfunctions should be considered at an early stage in the clinical course of patients with subarachnoid hemorrhages of a severe neurological grade. Appropriate pre- and post-operative intensive care is important when planning direct surgery for cerebral aneurysms.
一般社団法人日本救急医学会の論文
2003-04-15

重症クモ膜下出血症例におけるSOFA scoreを用いた臓器障害の検討

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