᪥ᚰ➨ 㻣㻡 ᅇ኱఍䠄㻞㻜㻝㻝䠅㻌
⮫ᗋ䞉㞀ᐖ㻌㻝㻼㻹㻜㻣㻡㻌
⑓㝔ᚰ⌮⮫ᗋ࡛ࡢ⥅᫬ⓗⓎ㐩᳨ᰝࡢ᭷⏝ᛶ࡟ࡘ࠸࡚ II
㸫Ỉ㢌⑕ࢆᣢࡘඣࡢᑵᏛ๓ࡢㄆ▱Ⓨ㐩ࡢ᳨ウ㸫 ‫ۑ‬ᩧ⸨࿴ᜨ࣭஭⏣༤ᖾ㠀఍ဨ
㸦ᮾிឿᜨ఍་⛉኱Ꮫᑠඣ⛉Ꮫㅮᗙ㸧
࣮࣮࢟࣡ࢻ: ㄆ▱Ⓨ㐩ホ౯ࠊEBMࠊᚰ⌮⮫ᗋ◊✲
Longitudinal Assessment of Mental Development in Children with Hydrocephalus at University Hospital
Kazue SAITO, Hiroyuki IDA
(Department of Pediatrics, Jikei Univ. School of Medicine)
Key words: Assessment of cognitive development, Evidence based medicine, Psychological Clinical research
┠ ⓗ
Ꮚ࡝ࡶࡢỈ㢌⑕ࡢㄆ▱ᶵ⬟࡟ࡘ࠸࡚ࡢሗ࿌ࡣᑡ࡞࠸ࡀࠊᡂ
ேࡢṇᖖᅽỈ㢌⑕ࡢᶵ⬟㞀ᐖ◊✲࠿ࡽグ᠈ຊࡢపୗࠊどぬᛶ
ࡢὀព㞀ᐖࠊసືグ᠈ࠊ⢭⚄㐠ືࡸᛮ⪃㏿ᗘࡢపୗࠊᴫᛕ㌿
᥮ࡢ㞀ᐖ࡞࡝ࡀሗ࿌ࡉࢀ࡚࠸ࡿࠋᮏ◊✲࡛ࡣࠊஙᗂඣᮇ࠿ࡽ
ᑠඣ⬻⚄⤒እ⛉࡟ཷデࡋࠊ἞⒪࡜㛗ᮇ⤒㐣ほᐹࢆཷࡅ࡚࠸ࡿ
Ỉ㢌⑕ࡢ⢭⚄㐠ືⓎ㐩࡟ࡘ࠸᳨࡚ウࡋࡓࠋᏛ㱋ᮇࡲ࡛ࡢⓎ㐩
ࡢ⤒ᖺⓗኚ໬ࢆᢕᥱࡋㄆ▱ᶵ⬟ࡢ㉁ⓗ᳨ウࢆ⾜ࡗࡓࠋᗂඣᮇ
࠿ࡽࡢ᪩ᮇࡢⓎ㐩ᨭ᥼ࢆ⾜࠺ࡇ࡜࡛Ꮫ❺ᮇ௨㝆࡟ண ࡉࢀࡿ
஧ḟⓗ㞀ᐖ࡛࠶ࡿᏛ⩦㞀ᐖࡸ⾜ື␗ᖖࠊຎ➼ឤ࡞࡝ᚰ⌮♫఍
ⓗ㞀ᐖࢆண㜵ࡍࡿࡇ࡜ࢆ㛗ᮇࡢ┠ⓗ࡜ࡍࡿࠋ
᪉ ἲ
ᑐ㇟ࡣࠊ ᖺ ᭶࠿ࡽ ᖺ ᭶ࡲ࡛࡟኱Ꮫ⑓㝔ᑠඣ
⬻እ⛉࡟ึᅇཷデࡋࠊ⬻⚄⤒Ꮫⓗ἞⒪ᚋ࡟Ⓨ㐩ࣇ࢛࣮ࣟࢆཷ
ࡅࡓỈ㢌⑕ඣ ே㸦ᖹᆒ᭶㱋 ࣨ᭶s ࣨ᭶㸧࡛࠶
ࡿࠋ᪉ἲࡣ᪂∧㹉ᘧⓎ㐩᳨ᰝἲࢆ⏝࠸ࡓࠋ᳨ᰝෆᐜࡣࠊጼໃ࣭
㐠ື㡿ᇦ㸦30࡜␎ࡍࠊᮏ㡿ᇦࡢⓎ㐩᳨ᰝࡣ ṓ༙ࡀୖ㝈㸧ࠊ
ㄆ▱࣭㐺ᛂ㡿ᇦ㸦&$࡜␎ࡍ㸧ࠊゝㄒ࣭♫఍㡿ᇦ㸦/6࡜␎ࡍ㸧
ࡢ 㡿ᇦࡢୗ఩᳨ᰝ࡛ᵓᡂࡉࢀࠊ᳨ᰝ⤖ᯝࡣୗ఩㡿ᇦྛ '4
࡜ୗ఩㡿ᇦ⥲ྜ࡜ࡋ࡚඲㡿ᇦ '4㸦඲ '4 ࡜␎ࡍ㸧ࡀ⟬ฟࡉࢀ
ࡿࠋ⵳✚ⓗ࡟཰㞟ࡋࡓ ౛ࡢⓎ㐩᳨ᰝ⤖ᯝࢆࡶ࡜࡟ศᩓศ
ᯒࠊȮ㸰᳨ᐃࢆ⏝࠸࡚ඣࡢ⢭⚄㐠ືⓎ㐩ࡢ≉ᚩࢆ⤫ィᏛⓗ࡟
ゎᯒࡋࡓࠋஙᗂඣᮇ࡟࠾ࡅࡿⓎ㐩᳨ᰝࡢ⤖ᯝࢆⓎ㐩㡿ᇦูࠊ
ᙧែ㸦እỈ㢌⑕ࠊ⬻ᐊᣑ኱㸧ࠊཎᅉ㸦⾑⟶㞀ᐖࠊ㢌⵹ෆࡢ࠺⬊ࠊ
ឤᰁ⑕ࠊ஧ศ⬨᳝ࠊ஧ศ㢌⵹ࠊ㢌⵹㦵⦭ྜ᪩ᮇ⒵ྜ⑕ࠊ⭘⒆ࠊ
እയࠊ୰⬻Ỉ㐨㛢ሰࠊ࣮ࣔࣥࣟᏍ㛢ሰࠊࡑࡢ௚ࡢወᙧ㸧࡞࡝
ࡢせᅉ࡛ẚ㍑ࡍࡿ࡜࡜ࡶ࡟Ⓨ㐩ࡢ⥅᫬ⓗኚ໬࡟ࡘ࠸᳨࡚ウࡋ
ࡓࠋⓎ㐩ẁ㝵༊ศࡣࠊ඲㡿ᇦ '4 ࢆ '4!㸦ᖹᆒ௨ୖ㸧ࠊ'4
㸦ᖹᆒ௨ୗ㸧ࠊ'4㸦୰ᗘ࣭㍍ᗘ㐜⁫㸧ࠊ'4㸦㔜ᗘ㐜⁫㸧
࡜ࡋࠊྛせᅉ࡟࠾࠸࡚ࡢⓎ㐩ẁ㝵ࡢேᩘẚ⋡ࢆẚ㍑ࡋࡓࠋ
⤖ ᯝ ࡜ ⪃ ᐹ
Ỉ㢌⑕ࡢྛⓎ㐩㡿ᇦ '4 ᖹᆒsᶆ‽೫ᕪࡣࠊ30'4s
㸦㸱ṓ௦ࡲ࡛㸧ࠊ&$'4sࠊ/6'4sࠊ඲
'4s ࡛࠶ࡗࡓࠋஙඣᮇࠊᗂඣᮇ๓༙ࡢ &$ 㡿ᇦ㸦ど
✵㛫ㄆ▱㸧ࡢⓎ㐩ࡣ /6 㡿ᇦ㸦ゝㄒࡢሙࡢ⌮ゎ࡜♫఍ᛶ㸧࡟
ẚ㍑ࡋ࡚᭷ព࡟㐜ࡃࠊ30 㡿ᇦ࡟࠾࠸࡚ጼໃ࣭㐠ືⓎ㐩ࡣ௚
ࡢⓎ㐩㡿ᇦ࡟ẚ㍑ࡋ࡚᭷ព࡟㐜࠿ࡗࡓࠋ
ᙧែࡢせᅉ࡛ࡢⓎ㐩ẁ㝵༊ศࡢẚ⋡ࡣ '4 ࡛ࠊእỈ㢌⑕
ࠊ⬻ᐊᣑ኱ ࠊ'4! ௨ୖ࡛እỈ㢌⑕ ࠊ⬻ᐊ
ᣑ኱ ࡜࡞ࡾࠊ⬻ᐊᣑ኱࡛ࡢ '4 ࡢ⋡ࡣ᭷ព࡟㧗ࡃࠊ
'4! ࡢẚ⋡ࡣ᭷ព࡟ప࠸࡜࠸࠼ࡓࠋཎᅉ࡟ࡼࡿⓎ㐩ẁ㝵༊
ศࡢẚ⋡ࡣࠊ'4 ࡛⾑⟶㞀ᐖ ࠊឤᰁ⑕ ࠊ'4!
࡛ࡣࠊ⾑⟶㞀ᐖ ࠊឤᰁ⑕ ࡜࡞ࡾࠊ⾑⟶㞀ᐖࠊឤᰁ⑕࡛
ࡢ '4 ࡢẚ⋡ࡣ᭷ព࡟㧗ࡃࠊ'4! ࡢẚ⋡ࡣ᭷ព࡟ప࠿ࡗ
ࡓ㸦ᅗ㸯㸧
ࠋ࠸ࡎࢀࡢⓎ㐩㡿ᇦ࡟࠾࠸࡚ࡶ⾑⟶㞀ᐖࠊឤᰁ⑕ࡢ
'4 ࡣ᭷ព࡟పࡃࠊ㢌⵹㦵⦭ྜ᪩ᮇ⒵ྜ⑕ࡣ /6 㡿ᇦࠊ඲㡿ᇦ
࡟࠾࠸࡚እയࠊ୰⬻Ỉ㐨㛢ሰ࡟ẚ㍑ࡋ '4 ࡀ᭷ព࡟ప࠿ࡗࡓࠋ
⬻ᐊෆฟ⾑ࡸ㧊⭷⅖࡞࡝ࡢ⾑⟶㞀ᐖࡸឤᰁ⑕ࡣࠊࡼࡾᗈ⠊ᅖ
࡟⬻ᐇ㉁ࢆෑࡍࡓࡵ࡟ࠊ௚ࡢཎᅉ࡟ẚ㍑ࡋ࡚㢧ⴭ࡞Ⓨ㐩ࡢ㐜
ࢀࡀ࠶ࡿ࡜⪃࠼ࡽࢀࠊእയࡣࡶ࡜ࡶ࡜ṇᖖ࡟Ⓨ㐩ࡋ࡚ࡁࡓࡶ
ࡢ࡛ࠊࡼ࡯࡝㔜⑕࡛࡞࠸㝈ࡾࡣⓎ㐩ࡀᖹᆒⓗ࡞⠊ᅖ࡟ಖࡓࢀ
ࡿഴྥࡀ࠶ࡗࡓࠋỈ㢌⑕ࢆࡶࡘඣ࡟࠾࠸࡚ࡣࠊࡑࡢཎᅉࢆ⪃
៖ࡋࡓ࠺࠼࡛ࡢ㛗ᮇࡢⓎ㐩ᨭ᥼ࡀᚲせ࡛࠶ࡿࠋỈ㢌⑕ඣࡢྛ
Ⓨ㐩㡿ᇦ '4 ࡢᖺ௦ⓗኚ໬ࡳࡿ࡜ࠊ'4 ࡣ࠸ࡎࢀࡢ㡿ᇦ࡟࠾࠸
࡚ࡶ㸰ṓ࠿ࡽ㸲ṓ࡛ᩘ್ⓗ࡟ࡣ೵⁫ࡍࡿࡀࠊ ṓ࠿ࡽୖ᪼ࡋ
࡚⾜ࡃഴྥࡀࡳࡽࢀ㸦ᅗ㸰㸧ࠊ'4 ࡢẚ⋡ࡣ ṓ௨㝆࡛ῶᑡ
ࡋ࡚࠸ࡓࠋ௨ୖ࠿ࡽࠊỈ㢌⑕࡟࠾࠸࡚ࡶஙඣᮇ࡟㐺ษ࡞⬻⚄
⤒Ꮫⓗ࣭἞⒪ⓗ௓ධࡀ࡞ࡉࢀࢀࡤࠊࡑࡢᚋࡢ⬻Ⓨ㐩ࡀಁ㐍ࡉ
ࢀࠊ ṓ࠿ࡽ ṓ࡛㞟ᅋ⏕άࡀ㛤ጞࡉࢀࡿ࡞࡝⎔ቃせᅉ࡜ࡢ
┦஌ຠᯝࡀᮇᚅࡉࢀࡿ᫬ᮇ࡟ࡣࠊඣࡢⓎ㐩ࡀ඲యⓗ࡟ಁ㐍ࡉ
ࢀࡿഴྥࡀ♧ࡉࢀࡓࠋஙᗂඣᮇࡢ⢭⚄㐠ືⓎ㐩ࡢ㐜ࢀࡀ⬻እ
⛉ⓗ἞⒪௓ධ࡜㛗ᮇࣇ࢛࣮ࣟ࢔ࢵࣉ࡛ࡢᣦᑟࠊᐙᗞࡸ♫఍⏕
ά࡜ࡢ┦஫స⏝࡟ࡼࡗ࡚ᗂඣᮇᚋᮇ࡟ࡣㄆ▱Ⓨ㐩ࡀಁ㐍ࡉࢀ
ࡿࡇ࡜ࡀ☜ㄆ࡛ࡁࡓࠋỈ㢌⑕඲య࡛ࡢ '4! ࡢẚ⋡ࡣࠊ⏨Ꮚ
࡛ ࠊዪᏊ࡛ ࡛࠶ࡗࡓࡀࠊୗ఩㡿ᇦ࡟㸯ࡘ࡛ࡶ '4
௨ୖࢆᣢࡘ ౛ࢆࢡࣛࢫࢱศᯒࡍࡿ࡜ࠊ⩌㸯&$ '4
s ࠊ /6'4 s ࡜ ⩌ 㸰 &$'4 s ࠊ
/6'4s࡟ศࡅࡽࢀࡓࠋ㧗ḟ⬻ᶵ⬟ࢆᣢࡘỈ㢌⑕ඣ
ࡢⓎ㐩ࡢ⥅᫬ⓗኚ໬࡜㉁ⓗศᯒ࡟ࡘ࠸࡚ࡣ௒ᚋࡢㄢ㢟࡛࠶ࡿࠋ
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