外側型高血圧性脳内血腫の社会復帰に及ぼす諸因子

概要

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In order to complete the surgical treatment of intracerebral hematomas due to hypertension located in the basal nuclei, it is necessary to obtain preoperatively a correct estimate for the possibility of postoperative rehabilitation of the patient, besides saving the patient's life. Prerequisites for this purpose have been mentioned and discussed by many authors, but none of them appear to be satisfactory. In the study to be presented in this paper, a detailed investigation was made of cerebral angiograms obtained from patients with an established diagnosis of an intracerebral hematoma of the lateral type. Two points at which two lines which join the median point of A1 and the displaced Sylvian point and the estimated normal Sylvian point intersect the lateral branch of the striate artery (vascular intersection ratio) and the angle made between these lines were taken as the basic criteria for determining whether or not the patient will fall into a disabled state postoperatively. In addition to this morphological evaluation of cerebral angiograms, parameters such as the acid-base balance of the blood and cerebrospinal fluid and respiratory function, paticularly A-aDO2, shunt rate and physiological dead space rate, were also studied both pre-and postoperatively to obtain an estimate of existing functional disturbance due to intracerbral hematoma. These procedures were found to be of great value in the prognosis for postoperative disability.