腎不全を合併した脳卒中患者の治療戦略(<特集>全身管理を要する脳血管障害の治療)

概要

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We retrospectively analyzed 40 cerebral apoplectic patients with renal failure. Diagnoses included intracerebral hemorrhage (ICH) in 26, subarachnoid hemorrhage (SAH) in 12, intraventricular hemorrhage in 1 and hemorrhagic infarction in 1. Treatment for renal failure was continuous ambulatory peritoneal dialysis (CAPD) in 24, hemodialysis (HD) in 8 and continuous hemodiafiltration (CHDF) in 8. Conservative treatment was performed in 21 of 26 ICH patients. Surgical repair with neck clipping was performed in 8 of 12 SAH patients. Endovascular treatment with Guglielmi detachable coil was performed in 1. The mortality rate with ICH and SAH was 31% and 67%, respectively. The major risk factors were hemorrhagic tendency and initial damage to the brain. The hemorrhagic tendency in CAPD, HD and CHDF was 8%, 25% and 25%, respectively. Brain edema was not a major problem in each of the 3 methods. Extracorporeal circulation using anticoaglant agents in HD and CHDF was also considered to account for the high incidence of hemorrhagic tendency. As compared with HD and CHDF, CAPD was considered more appropriate for the cerebral apoplectic patients with renal failure. Early initiation and frequent dialysis with CAPD are crucial to the effective treatment for such patients.
日本脳卒中の外科学会の論文
2000-07-31