高血圧性脳内出血の外科的リスクの因子分析

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The indication of surgery for hypertensive intracerebral haemorrhage has been customarily determined by the location, extension and amount of bleeding as well as the presence or absence of brain stem symptoms. A comparison of therapeutic results was made between 40 operative cases and another 40 non-operative cases (comprising a group of cases in which medical treatment was the only therapeutic measure justifiable and another group of cases of minor haemorrhage), notably in relation to 4 different factors of therapeutic as well as prognostic importance, i.e. the location and extension of haematoma, the severity of distance of consciousness, the presence or absence of brain stem symptoms and age. The results indicated that these 4 factors may not necessarily be a determinant of therapeutic outcome. In order to determine the grade and surgical risk of hypertensive intracerebral haemorrhage, a system of coordinates was worked out in which the 4 factors are plotted on abscissae and ordinates so that the 1st and 2nd quadrants might pertain to pathological conditions arising from hypertension and the 3rd quadrant might be relevant to repercussions of intracerebral haemorrhage on structures and functions of the body. A study of plots of values for variables relevant to therapeutic result on this system of coordinates led to the following conclusions: 1) The time interval between haemorrhage and operation as same as location of haematoma is an important determinant of prognosis. 2) Respiratory disturbance does not seem to worsen the prognosis in cases where surgery is performed early in the course of the condition, whereas it can seriously affect the outcome of operation performed 4 days or more after the onset of a bleeding episode. Intestinal haemorrhage as a complication is not only life-threatening but does also greatly interfere with the recovery of function. 3) Medical treatment can reasonably assure the recovery of lost or impaired function in only those cases with minor haemorrhage where there are no appreciable somatic symptoms due to hypertension. 4) Through the graphic representation of pertinent data on that particular system of coordinates, one can clearly indicate both the therapeutic result of and limitations to operation. In summary, the results of the present analytical study point to the necessity of paying due consideration to impairment of bodily functions due to a haematoma, disturbance of respiratory function resulting from hypertension as well as the severity and changes with time of brain damage due to haematoma per se in evaluating the grade and surgical risk of the disease in question.

高血圧性脳内出血の外科的リスクの因子分析

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