慢性血液透析患者におけるくも膜下出血の治療

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It has been generally accepted that perioperative management is quite difficult with chronically hemodialized patients who suddenly develop subarachnoid hemorrhage (SAH) due to a ruptured aneurysm. Two main problems are present: hemorrhagic tendency caused by platelet hypofunction and excessive brain swelling elicited by disequilibrium syndrome during and after the operation. We experienced 7 of these cases in our institutes during the past 7 years. Direct surgery was performed in 5 mild and moderate SAH cases and embolization using GDC in 2 severe SAH cases. Postoperative hemodialysis was usually performed intermittently for mild and moderate SAH patients using short-acting anticoagulants following installation of intracranial pressure monitoring. This treatment was well tolerated without any untoward effect. However, we were sometimes obliged to continuously perform hemodialysis. For the patients with a fluctuating intracranial pressure, continuous hemodiafiltration was chosen, and for the patients suffering from impending intracerebral hemorrhage or hematoma, continuous amubulatory peritoneal dialysis was used for several days. Overall outcome was satisfactory except for 2 surgical cases with a massive intracerebral hematoma and/or large infarction related to the original aneurysmal rupture. Although our experience is small, we strongly feel that GDC embolization is likely to be an effective and promising treatment of choice especially for such severe SAH hemodialized patients.
日本脳卒中の外科学会の論文
2000-01-31

慢性血液透析患者におけるくも膜下出血の治療

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