頭部外傷の病態と治療

「はじめに」外傷による死亡は解決すべき世界共通の問題である. 2014年のWHOレポートによると, 外傷による死亡者数は全世界でおよそ年間500万人とされ, 全死亡原因の9%にあたる. これはHIV/AIDS, 結核, マラリアによる総死亡者数の1.7倍にも匹敵する. また15歳～29歳の若年者死亡原因の第1位が交通外傷であり, 生産年齢人口を減ずる要因にもなっている. 発展途上国, 特にモータリゼーションが急速に進んでいるインドやカンボジアなどでは, この10年間で交通事故死亡患者が1.5～2倍に増加しており, 救急医療体制の確立が急務とされている. このように外傷患者の増加は, 医療・経済...

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Published in日本医科大学医学会雑誌 Vol. 15; no. 2; pp. 71 - 79
Main Authors 横堀, 將司, 横田, 裕行
Format Journal Article
LanguageJapanese
Published 日本医科大学医学会 15.04.2019
Online AccessGet full text
ISSN1349-8975
1880-2877
DOI10.1272/manms.15.71

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Abstract 「はじめに」外傷による死亡は解決すべき世界共通の問題である. 2014年のWHOレポートによると, 外傷による死亡者数は全世界でおよそ年間500万人とされ, 全死亡原因の9%にあたる. これはHIV/AIDS, 結核, マラリアによる総死亡者数の1.7倍にも匹敵する. また15歳～29歳の若年者死亡原因の第1位が交通外傷であり, 生産年齢人口を減ずる要因にもなっている. 発展途上国, 特にモータリゼーションが急速に進んでいるインドやカンボジアなどでは, この10年間で交通事故死亡患者が1.5～2倍に増加しており, 救急医療体制の確立が急務とされている. このように外傷患者の増加は, 医療・経済を圧迫する世界的問題である. 外傷の中でも特に頭部外傷患者の頻度は高い. 日本外傷データバンク(Japan Trauma Data Bank, JTDB)の報告では, 2012年から2016年の4年間で, 入院を要した頭部外傷患者は20,830人であり, 骨折など下肢外傷の発生率とほぼ同等であった.
AbstractList 「はじめに」外傷による死亡は解決すべき世界共通の問題である. 2014年のWHOレポートによると, 外傷による死亡者数は全世界でおよそ年間500万人とされ, 全死亡原因の9%にあたる. これはHIV/AIDS, 結核, マラリアによる総死亡者数の1.7倍にも匹敵する. また15歳～29歳の若年者死亡原因の第1位が交通外傷であり, 生産年齢人口を減ずる要因にもなっている. 発展途上国, 特にモータリゼーションが急速に進んでいるインドやカンボジアなどでは, この10年間で交通事故死亡患者が1.5～2倍に増加しており, 救急医療体制の確立が急務とされている. このように外傷患者の増加は, 医療・経済を圧迫する世界的問題である. 外傷の中でも特に頭部外傷患者の頻度は高い. 日本外傷データバンク(Japan Trauma Data Bank, JTDB)の報告では, 2012年から2016年の4年間で, 入院を要した頭部外傷患者は20,830人であり, 骨折など下肢外傷の発生率とほぼ同等であった.
Author 横田, 裕行
横堀, 將司
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References 41. Clifton GL, Miller ER, Choi SC, et al.: Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 2001; 344: 556-563.
2. Japan Trauma Care and Research (日本外傷診療機構): Japan Trauma Data Bank Report 2017 https://www.jtcr-jatec.org/traumabank/dataroom/data/JTDB2017.pdf (2018.12.16 accessed).
10. 卯津羅 雅彦, 奥野 憲司, 小川 武希ほか: 転帰からみた重症頭部外傷の現状: 頭部外傷データバンクから. 神経外傷 2008; 31: 107-112.
17. Garvin R, Venkatasubramanian C, Lumba-Brown A, Miller CM: Emergency Neurological Life Support: Traumatic Brain Injury. Neurocrit Care 2015; 23 (Suppl 2): S143-S154.
13. Marmarou A, Signoretti S, Fatouros PP, Portella G, Aygok GA, Bullock MR: Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries. J Neurosurg 2006; 104: 720-730.
45. Morgalla MH, Will BE, Roser F, Tatagiba M: Do long-term results justify decompressive craniectomy after severe traumatic brain injury? J Neurosurg 2008; 109: 685-690.
21. Maas AI, Dearden M, Servadei F, Stocchetti N, Unterberg A: Current recommendations for neurotrauma. Curr Opin Crit Care 2000; 6: 281-292.
11. Kramer DR, Winer JL, Pease BA, Amar AP, Mack WJ: Cerebral vasospasm in traumatic brain injury. Neurol Res Int 2013; 2013: 415813.
25. Bullock MR, Chesnut R, Ghajar J, et al.: Surgical management of posterior fossa mass lesions. Neurosurgery 2006; 58: S47-55; discussion Si-iv.
37. Battison C, Andrews PJ, Graham C, Petty T: Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injuryCrit Care Med. 2005; 33: 196-202; discussion 57-8.
32. Ledwith MB, Bloom S, Maloney-Wilensky E, Coyle B, Polomano RC, Le Roux PD: Effect of body position on cerebral oxygenation and physiologic parameters in patients with acute neurological conditions. J Neurosci Nurs 2010; 42: 280-287.
4. Yokobori S, Yamaguchi M, Igarashi Y, et al.: Outcome and Refractory Factor of Intensive Treatment for Geriatric Traumatic Brain Injury: Analysis of 1165 Cases Registered in the Japan Neurotrauma Data Bank. World Neurosurg 2016; 86: 127-133 e1.
23. Stevens RD, Huff JS, Duckworth J, Papangelou A, Weingart SD, Smith WS: Emergency neurological life support: intracranial hypertension and herniation. Neurocrit Care 2012; 17 (Suppl 1): S60-S65.
15. Carney N, Totten AM, O'Reilly C, et al.: Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery 2016.
18. 中山 晴雄, 荻野 雅宏, 永廣 信治, 岩淵 聡: 脳振盪・スポーツ頭部外傷の検査と対応. 脳外誌 2018; 27: 4-8.
30. Muizelaar JP, Marmarou A, Ward JD, et al.: Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg 1991; 75: 731-739.
33. Kerr EM, Marion D, Sereika MS, et al.: The effect of cerebrospinal fluid drainage on cerebral perfusion in traumatic brain injured adults. J Neurosurg Anesthesiol 2000; 12: 324-333.
49. Hutchinson PJ, Kolias AG, Timofeev IS, et al.: Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension. N Engl J Med 2016; 375: 1119-1130.
40. Sakellaridis N, Pavlou E, Karatzas S, et al.: Comparison of mannitol and hypertonic saline in the treatment of severe brain injuries. J Neurosurg 2011; 114: 545-548.
44. Taylor A, Butt W, Rosenfeld J, et al.: A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst 2001; 17: 154-162.
42. Clifton GL, Valadka A, Zygun D, et al.: Very early hypothermia induction in patients with severe brain injury (the National Acute Brain Injury Study: Hypothermia II): a randomised trial. Lancet Neurol 2011; 10: 131-139.
47. Honeybul S, Ho KM, Lind CR, Gillett GR: The future of decompressive craniectomy for diffuse traumatic brain injury. J Neurotrauma 2011; 28: 2199-2200.
39. Cooper DJ, Myles PS, McDermott FT, et al.: Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. JAMA 2004; 291: 1350-1357.
20. 横堀, 將司: 神経集中治療: 頭蓋内圧モニタリングと管理. Intensivist 2013; 5 (3): 525-537.
28. Bullock MR, Chesnut R, Ghajar J, et al.: Surgical management of acute epidural hematomas. Neurosurgery 2006; 58: S7-15; discussion Si-iv.
24. Bullock MR, Chesnut R, Ghajar J, et al.: Surgical management of traumatic parenchymal lesions. Neurosurgery 2006; 58: S25-46; discussion Si-iv.
52. Eisenberg HM, Frankowski RF, Contant CF, Marshall LF, Walker MD: High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury. J Neurosurg 1988; 69: 15-23.
14. Cooper DJ, Rosenfeld JV, Murray L, et al.: Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011; 364: 1493-1502.
36. Vialet R, Albanese J, Thomachot L, et al.: Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2 mL/kg 7.5% saline is more effective than 2 mL/kg 20% mannitol. Crit Care Med 2003; 31: 1683-1687.
50. Schwartz ML, Tator CH, Rowed DW, Reid SR, Meguro K, Andrews DF: The University of Toronto head injury treatment study: a prospective, randomized comparison of pentobarbital and mannitol. Can J Neurol Sci 1984; 11: 434-440.
6. Yokota H, Naoe Y, Nakabayashi M, et al.: Cerebral endothelial injury in severe head injury: the significance of measurements of serum thrombomodulin and the von Willebrand factor. J Neurotrauma 2002; 19: 1007-1015.
19. Saunders RL, Harbaugh RE: The second impact in catastrophic contact-sports head trauma. JAMA 1984; 252: 538-539.
22. Patel HC, Menon DK, Tebbs S, Hawker R, Hutchinson PJ, Kirkpatrick PJ: Specialist neurocritical care and outcome from head injury. Intensive Care Med 2002; 28: 547-553.
31. Ng I, Lim J, Wong HB: Effects of head posture on cerebral hemodynamics: its influences on intracranial pressure, cerebral perfusion pressure, and cerebral oxygenation. Neurosurgery 2004; 54: 593-597; discussion 8.
48. Kitagawa RS, Bullock MR: Lessons from the DECRA Study. World Neurosurg 2012.
3. 重症頭部外傷治療・管理のガイドライン作成委員会編, 日本脳神経外科学会, 日本脳神経外傷学会監修: 重症頭部外傷治療・管理のガイドライン. 第3版, 2013; 医学書院 東京.
1. World Health Organization: Injuries and Violence, the Fact 2014. http://www.who.int/violence_injury_prevention/en/ (2018.12.16 accessed).
5. Yokobori S, Watanabe A, Matsumoto G, et al.: Lower extracellular glucose level prolonged in elderly patients with severe traumatic brain injury: a microdialysis study. Neurol Med Chir (Tokyo) 2011; 51: 265-271.
35. White H, Cook D, Venkatesh B: The use of hypertonic saline for treating intracranial hypertension after traumatic brain injury. Anesth Analg 2006; 102: 1836-1846.
7. Mendelow AD, Gregson BA, Rowan EN, et al.: Early Surgery versus Initial Conservative Treatment in Patients with Traumatic Intracerebral Hemorrhage (STITCH[Trauma]): The First Randomized Trial. J Neurotrauma 2015.
27. Bullock MR, Chesnut R, Ghajar J, et al.: Surgical management of acute subdural hematomas. Neurosurgery 2006; 58: S16-24; discussion Si-iv.
34. Knapp JM: Hyperosmolar therapy in the treatment of severe head injury in children: mannitol and hypertonic saline. AACN Clin Issues 2005; 16: 199-211.
16. 日本外傷学会, 日本救急医学会監修: 外傷初期診療ガイドライン. 第5版, 2013; へるす出版 東京.
29. Kelly DF, Goodale DB, Williams J, et al.: Propofol in the treatment of moderate and severe head injury: a randomized, prospective double-blinded pilot trial. J Neurosurg 1999; 90: 1042-1052.
26. Bullock MR, Chesnut R, Ghajar J, et al.: Surgical management of depressed cranial fractures. Neurosurgery 2006; 58: S56-60; discussion Si-iv.
46. Cooper DJ, Rosenfeld JV, Murray L, et al.: Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011; 364: 1493-1502.
43. Yokobori S, Gajavelli S, Mondello S, et al.: Neuroprotective effect of preoperatively induced mild hypothermia as determined by biomarkers and histopathological estimation in a rat subdural hematoma decompression model. J Neurosurg 2012.
8. Moenninghoff C, Kraff O, Maderwald S, et al.: Diffuse axonal injury at ultra-high field MRI. PLoS One 2015; 10: e0122329.
9. Maas AI, Steyerberg EW, Butcher I, et al.: Prognostic value of computerized tomography scan characteristics in traumatic brain injury: results from the IMPACT study. J Neurotrauma 2007; 24: 303-314.
12. Bouma GJ, Muizelaar JP, Fatouros P: Pathogenesis of traumatic brain swelling: role of cerebral blood volume. Acta Neurochir Suppl 1998; 71: 272-275.
38. Pascual JL, Maloney-Wilensky E, Reilly PM, et al.: Resuscitation of hypotensive head-injured patients: is hypertonic saline the answer? Am Surg 2008; 74: 253-259.
51. Ward JD, Becker DP, Miller JD, et al.: Failure of prophylactic barbiturate coma in the treatment of severe head injury. J Neurosurg 1985; 62: 383-388.
References_xml – reference: 16. 日本外傷学会, 日本救急医学会監修: 外傷初期診療ガイドライン. 第5版, 2013; へるす出版 東京.
– reference: 20. 横堀, 將司: 神経集中治療: 頭蓋内圧モニタリングと管理. Intensivist 2013; 5 (3): 525-537.
– reference: 32. Ledwith MB, Bloom S, Maloney-Wilensky E, Coyle B, Polomano RC, Le Roux PD: Effect of body position on cerebral oxygenation and physiologic parameters in patients with acute neurological conditions. J Neurosci Nurs 2010; 42: 280-287.
– reference: 6. Yokota H, Naoe Y, Nakabayashi M, et al.: Cerebral endothelial injury in severe head injury: the significance of measurements of serum thrombomodulin and the von Willebrand factor. J Neurotrauma 2002; 19: 1007-1015.
– reference: 15. Carney N, Totten AM, O'Reilly C, et al.: Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery 2016.
– reference: 10. 卯津羅 雅彦, 奥野 憲司, 小川 武希ほか: 転帰からみた重症頭部外傷の現状: 頭部外傷データバンクから. 神経外傷 2008; 31: 107-112.
– reference: 7. Mendelow AD, Gregson BA, Rowan EN, et al.: Early Surgery versus Initial Conservative Treatment in Patients with Traumatic Intracerebral Hemorrhage (STITCH[Trauma]): The First Randomized Trial. J Neurotrauma 2015.
– reference: 12. Bouma GJ, Muizelaar JP, Fatouros P: Pathogenesis of traumatic brain swelling: role of cerebral blood volume. Acta Neurochir Suppl 1998; 71: 272-275.
– reference: 42. Clifton GL, Valadka A, Zygun D, et al.: Very early hypothermia induction in patients with severe brain injury (the National Acute Brain Injury Study: Hypothermia II): a randomised trial. Lancet Neurol 2011; 10: 131-139.
– reference: 39. Cooper DJ, Myles PS, McDermott FT, et al.: Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. JAMA 2004; 291: 1350-1357.
– reference: 27. Bullock MR, Chesnut R, Ghajar J, et al.: Surgical management of acute subdural hematomas. Neurosurgery 2006; 58: S16-24; discussion Si-iv.
– reference: 9. Maas AI, Steyerberg EW, Butcher I, et al.: Prognostic value of computerized tomography scan characteristics in traumatic brain injury: results from the IMPACT study. J Neurotrauma 2007; 24: 303-314.
– reference: 13. Marmarou A, Signoretti S, Fatouros PP, Portella G, Aygok GA, Bullock MR: Predominance of cellular edema in traumatic brain swelling in patients with severe head injuries. J Neurosurg 2006; 104: 720-730.
– reference: 49. Hutchinson PJ, Kolias AG, Timofeev IS, et al.: Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension. N Engl J Med 2016; 375: 1119-1130.
– reference: 26. Bullock MR, Chesnut R, Ghajar J, et al.: Surgical management of depressed cranial fractures. Neurosurgery 2006; 58: S56-60; discussion Si-iv.
– reference: 28. Bullock MR, Chesnut R, Ghajar J, et al.: Surgical management of acute epidural hematomas. Neurosurgery 2006; 58: S7-15; discussion Si-iv.
– reference: 51. Ward JD, Becker DP, Miller JD, et al.: Failure of prophylactic barbiturate coma in the treatment of severe head injury. J Neurosurg 1985; 62: 383-388.
– reference: 41. Clifton GL, Miller ER, Choi SC, et al.: Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 2001; 344: 556-563.
– reference: 1. World Health Organization: Injuries and Violence, the Fact 2014. http://www.who.int/violence_injury_prevention/en/ (2018.12.16 accessed).
– reference: 11. Kramer DR, Winer JL, Pease BA, Amar AP, Mack WJ: Cerebral vasospasm in traumatic brain injury. Neurol Res Int 2013; 2013: 415813.
– reference: 25. Bullock MR, Chesnut R, Ghajar J, et al.: Surgical management of posterior fossa mass lesions. Neurosurgery 2006; 58: S47-55; discussion Si-iv.
– reference: 5. Yokobori S, Watanabe A, Matsumoto G, et al.: Lower extracellular glucose level prolonged in elderly patients with severe traumatic brain injury: a microdialysis study. Neurol Med Chir (Tokyo) 2011; 51: 265-271.
– reference: 4. Yokobori S, Yamaguchi M, Igarashi Y, et al.: Outcome and Refractory Factor of Intensive Treatment for Geriatric Traumatic Brain Injury: Analysis of 1165 Cases Registered in the Japan Neurotrauma Data Bank. World Neurosurg 2016; 86: 127-133 e1.
– reference: 24. Bullock MR, Chesnut R, Ghajar J, et al.: Surgical management of traumatic parenchymal lesions. Neurosurgery 2006; 58: S25-46; discussion Si-iv.
– reference: 43. Yokobori S, Gajavelli S, Mondello S, et al.: Neuroprotective effect of preoperatively induced mild hypothermia as determined by biomarkers and histopathological estimation in a rat subdural hematoma decompression model. J Neurosurg 2012.
– reference: 18. 中山 晴雄, 荻野 雅宏, 永廣 信治, 岩淵 聡: 脳振盪・スポーツ頭部外傷の検査と対応. 脳外誌 2018; 27: 4-8.
– reference: 38. Pascual JL, Maloney-Wilensky E, Reilly PM, et al.: Resuscitation of hypotensive head-injured patients: is hypertonic saline the answer? Am Surg 2008; 74: 253-259.
– reference: 8. Moenninghoff C, Kraff O, Maderwald S, et al.: Diffuse axonal injury at ultra-high field MRI. PLoS One 2015; 10: e0122329.
– reference: 45. Morgalla MH, Will BE, Roser F, Tatagiba M: Do long-term results justify decompressive craniectomy after severe traumatic brain injury? J Neurosurg 2008; 109: 685-690.
– reference: 29. Kelly DF, Goodale DB, Williams J, et al.: Propofol in the treatment of moderate and severe head injury: a randomized, prospective double-blinded pilot trial. J Neurosurg 1999; 90: 1042-1052.
– reference: 17. Garvin R, Venkatasubramanian C, Lumba-Brown A, Miller CM: Emergency Neurological Life Support: Traumatic Brain Injury. Neurocrit Care 2015; 23 (Suppl 2): S143-S154.
– reference: 47. Honeybul S, Ho KM, Lind CR, Gillett GR: The future of decompressive craniectomy for diffuse traumatic brain injury. J Neurotrauma 2011; 28: 2199-2200.
– reference: 3. 重症頭部外傷治療・管理のガイドライン作成委員会編, 日本脳神経外科学会, 日本脳神経外傷学会監修: 重症頭部外傷治療・管理のガイドライン. 第3版, 2013; 医学書院 東京.
– reference: 33. Kerr EM, Marion D, Sereika MS, et al.: The effect of cerebrospinal fluid drainage on cerebral perfusion in traumatic brain injured adults. J Neurosurg Anesthesiol 2000; 12: 324-333.
– reference: 37. Battison C, Andrews PJ, Graham C, Petty T: Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injuryCrit Care Med. 2005; 33: 196-202; discussion 57-8.
– reference: 34. Knapp JM: Hyperosmolar therapy in the treatment of severe head injury in children: mannitol and hypertonic saline. AACN Clin Issues 2005; 16: 199-211.
– reference: 19. Saunders RL, Harbaugh RE: The second impact in catastrophic contact-sports head trauma. JAMA 1984; 252: 538-539.
– reference: 30. Muizelaar JP, Marmarou A, Ward JD, et al.: Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg 1991; 75: 731-739.
– reference: 23. Stevens RD, Huff JS, Duckworth J, Papangelou A, Weingart SD, Smith WS: Emergency neurological life support: intracranial hypertension and herniation. Neurocrit Care 2012; 17 (Suppl 1): S60-S65.
– reference: 52. Eisenberg HM, Frankowski RF, Contant CF, Marshall LF, Walker MD: High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury. J Neurosurg 1988; 69: 15-23.
– reference: 46. Cooper DJ, Rosenfeld JV, Murray L, et al.: Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011; 364: 1493-1502.
– reference: 2. Japan Trauma Care and Research (日本外傷診療機構): Japan Trauma Data Bank Report 2017 https://www.jtcr-jatec.org/traumabank/dataroom/data/JTDB2017.pdf (2018.12.16 accessed).
– reference: 48. Kitagawa RS, Bullock MR: Lessons from the DECRA Study. World Neurosurg 2012.
– reference: 22. Patel HC, Menon DK, Tebbs S, Hawker R, Hutchinson PJ, Kirkpatrick PJ: Specialist neurocritical care and outcome from head injury. Intensive Care Med 2002; 28: 547-553.
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Snippet 「はじめに」外傷による死亡は解決すべき世界共通の問題である. 2014年のWHOレポートによると, 外傷による死亡者数は全世界でおよそ年間500万人とされ, 全死亡原因の9%にあたる. これはHIV/AIDS, 結核, マラリアによる総死亡者数の1.7倍にも匹敵する....
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StartPage 71
Title 頭部外傷の病態と治療
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Volume 15
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ispartofPNX 日本医科大学医学会雑誌, 2019/04/15, Vol.15(2), pp.71-79
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