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Slide
1.
1 「認知症」「寝たきり」を予防するための 脳卒中予防のポイント
2.
2 「認知症」「寝たきり」を予防するための 脳卒中予防のポイント
3.
平均寿命と健康寿命 3 要介護9.02年 要介護12.40年 厚⽣労働省「厚⽣科学審議会地域保健健康増進栄養部会」(平成26年10⽉1⽇) 健康寿命,⼥性のほうが⻑い 寝たきりの原因、約4割は脳⾎管疾患
4.
脳卒中患者の割合 4 脳梗塞が75.9%を占める 脳卒中の種類は3種類
5.
1.脳梗塞とはどんな病気か︖ 5
6.
2.脳梗塞は寝たきりの原因の最重要疾患 6 寝たきりの原因の4割は 脳卒中
7.
3.脳梗塞は若年性認知症の主要原因 認知症とは「記憶」「理解」「判断」など⾼次機能が障害される 7 ラクナ梗塞の多発⇒「無症候性脳梗塞」⇒若年性認知症の主要原因 *脳実質内の0.1mm-0.5mmくらいの細い⾎管 2 最も⼤切なのは⽣活習慣病対策 ・⾼⾎圧 ・⾼脂⾎症 ・糖尿病 さらにリスク管理も重要 ・喫煙
・多数の飲酒 1 脳ドックで早期に⾒つけることが可能1
8.
4.脳梗塞には3つの種類がある 8
9.
5.脳梗塞患者の死亡者数は年間約6万⼈ 死因別死亡数における脳⾎管疾患11万1973⼈ 脳梗塞による死亡総数6万4523⼈ 9 出⾎性梗塞 *平成27年度 • 早期の治療介⼊が予後を左右する • tPA •
⾎栓回収療法 ①死亡リスク ②脳梗塞のタイプ ③脳梗塞を起こした場所 最も重要な要素は時間
10.
6.脳梗塞ではどんな後遺症が残るのか 10認知症も脳梗塞の後遺症の⼀つである
11.
7.前触れのある脳梗塞がある 11 アテローム⾎栓性脳梗塞 ・突然、⼿⾜の⼒が抜ける ・⽚⽅だけ⼿⾜が痺れる ・⾔葉が⼀瞬でにくく、呂律が回らない ⼀過性脳虚⾎発作 *3カ⽉以内に20%が脳梗塞発症 脳ドックににてMRI/MRAによる精査をお勧めします
12.
8.脳梗塞になりやすい不整脈(⼼房細動) ⼼房細動≠動脈硬化 12 ⼼房細動=ストレス・睡眠不⾜・加齢 ⼼房細動とは 抗凝固薬により⾎栓ができないようにする
13.
9.慢性頭痛やめまいは脳梗塞と関係あるか︖ 13 脳ドックでのMRAで動脈瘤は⾒つけることができる CTでは動脈瘤は⾒つけられない
14.
10. ⾼⾎圧だけでなく低すぎる⾎圧も要注意 14 収縮期140以上 拡張期90以上では 脳卒中、⼼臓病、腎臓病リスク上昇 低⾎圧とは、収縮期が100以下 2015年英国での研究 ⼼疾患、脳卒中などの死亡率が約2倍 すぐに降圧薬を服⽤開始必要なのは 収縮期180以上
拡張期110以上
15.
11. 悪⽟コレステロール(LDL)に注意しよう 15 ⾷事運動療法が原則です 善⽟コレステロールと悪⽟コレステロールの関係
16.
12.親や兄弟に脳梗塞の⼈がいたら要注意 プロテインキナーゼCη遺伝⼦の⾮同義SNP(アミノ酸置換をともなう⼀塩基多型) は,脳梗塞のリスクを⾼める 16 1 プロテインキナーゼcエータが2個所置換されていると、脳梗塞発症リスクが2.8倍2 脳卒中遺伝リスク⼥性>男性 ⺟親が脳卒中既往の⼥性が脳卒中に羅患するリスクは80%⾼い 姉妹が脳卒中既往ある⼥性が脳卒中に羅患するリスクがそうでない⼥性の3倍 3 4 遺伝が全てではないですが より注意必要であり⼼配であれば脳ドックの受診をお勧めします
17.
13.⼿⾜の痺れと脳梗塞に関係はあるか 脳梗塞によって起こる痺れの特徴 17 左右どちらか⼀⽅に起こる ⼒が⼊らない、はしを落とすなど脱⼒を伴う 筋緊張が改善しても痺れの症状が改善しない 頸椎椎間板ヘルニア 末鞘動脈疾患 末鞘神経障害 痺れを⽣じる他の病気 疑わしい場合は⾃分で判断せず、医師の診察を受けて下さい
18.
14.脳梗塞の治療はどこまで進んでいるか︖ 18 ⾎栓が脳卒中に羅患するリスクは80%⾼い 姉妹が脳卒中既往ある⼥性が脳卒中に羅患するリスクがそうでない⼥性の3倍 ⾎栓溶解療法tPA1 4.5時間以内に投与が必要2
19.
中⼤脳動脈再開通率? 19 答え C 16.6% ⾎栓量が多く全⾝投与のrt-PAでは⼗分に溶解できない
20.
15.さらに進んだ脳梗塞の治療 ⾎栓回収療法 20船橋市の脳梗塞治療の現状は医療過疎と同じ厳しい現実
21.
船橋市で⾎栓回収療法⾏えるのは2施設のみ 21
22.
従来の点滴治療と最新カテーテル治療の違い 22 tPA治療では⼤きな⾎管の⾎栓に太⼑打ちできない tPAには時間制限が存在する tPAの問題点 ⾎栓回収療法の良い点(カテーテル治療) 発症から8時間以内に使⽤できる(最新の研究では24時間以内でも良好な成績) ⼤きな⾎管でも再開通可能(約90%) 24時間365⽇⾎栓回収療法⾏っている病院は 当院 脳神経外科のみ
23.
⾎栓回収療法の代表症例 23 89歳 男性 右⿇痺 失語 両側内頚動脈閉塞 右椎⾻動脈閉塞
24.
左内頚動脈に対し⾎栓回収療法施⾏ 24 https://www.youtube.com/watch?v= d_M95D5ShHg https://www.youtube.com/w atch?v=l_LeX3bb9Wk
25.
術後2⽇⽬ 25 https://www.youtube.com/watch?v=zh0jTc34xnU
26.
16.再発率50%(10年)に対する予防 26 ・抗⾎⼩板薬 アテローム⾎栓性脳梗塞、ラクナ梗塞 ・抗凝固薬 ⼼原性脳梗塞 再発するとより後遺障害は重くなる 脳梗塞の予防
27.
17.脳ドックで予知できる脳卒中は3割 27 脳梗塞 ・ラクナ梗塞 ・⼼源性塞栓性梗塞 ・アテローム⾎栓性梗塞 脳内出⾎ クモ膜下出⾎ クモ膜下出⾎は100%予知できる 3割の脳卒中は予知できるかもしれない
28.
18.脳ドックで分かることは 28 無症候性脳梗塞(⾃覚症状のない脳梗塞)が⾒つかる確率は、受診者の20% クモ膜下出⾎の原因となる動脈瘤の有無は100%分かる いずれにしても重要なのは⽣活習慣の改善です︕ 3割の脳卒中が予防できれば40万⼈の脳卒中による 寝たきり・認知症が防げるかも 2 1 ⽇本での脳卒中患者は年間120万⼈ 3 4
29.
19.脳梗塞にならないため⾎圧を意識する 29 「⾼⾎圧・糖尿病・⾼脂⾎症」 脳梗塞に関して注意したい⽣活習慣病は ⾼⾎圧が最重要のリスク︕
30.
20.⾃律神経のバランスを意識しましょう 30 ⼈⽣で最も⼤切な健康は⾃分の意志で獲得できます