重症くも膜下出血治療成績の推移 : 最近5年間の変化とその要因(<特集>重症くも膜下出血治療の新しい試み)

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We compared recent clinical results for the severe subarachnoid hemorrhage (WFNS Grade IV and V) with data obtained five years ago. Thirty-one patients (38.3%) among 81 cases of subarachnoid hemorrhage were rated as WFNS Grade IV or V from July 1993 to June 1994 (Former Group). In the 81 patients from July 1998 to June 1999, 33 patients (40.7%) were rated as Grade IV or V (Latter Group). In the Former Group, the patient was promptly controlled under deep sedation in the emergency room. After the angiogram, emergent craniotomy for neck clipping was performed, and cisternal irrigation with 60,000 units of urokinase in 500 ml of physiological saline was undertaken for 7-10 days. Induced hypertension was started when the neurological deterioration was observed. In the Latter Group, decompressive craniectomy was added in all severe patients. The fluid for cisternal irrigation was modified to urokinase and ascorbic acid in mock cerebrospinal fluid. The initiation of cerebral vasospasm was continuously monitored with transcranial doppler, and intraarterial fasudil infusion was performed when cerebral vasospasm was noticed. Among the 31 patients in the Former Group, 19 patients were treated surgically. The outcome of these patients at hospital discharge was MD 3, SD 8, VS 3, D 5 in the Glasgow Outcome Scale. In the 21 surgically treated patients among 33 of the Latter Group, the outcome was GR, 4; MD, 5; SD, 2; VS, 8; and D, 2. The population who can live independently (GR + MD) was 15.8% in the Former Group and 42.9% in the Latter Group. Control of intracranial pressure in the initial stage, early detection and aggressive treatment of cerebral vasospasm, and development of intravascular treatment were considered to have contributed to this improvement of clinical results.
日本脳卒中の外科学会の論文
2001-07-31

重症くも膜下出血治療成績の推移 : 最近5年間の変化とその要因(<特集>重症くも膜下出血治療の新しい試み)

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