遅発性脳虚血に対する対策:-高度のクモ膜下出血に対する早期手術とアルブミン療法の併用-

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概要

• 論文の詳細を見る

• Although the effectiveness of early operation has been reported for the prevention of symptomatic vasospasm, good results have been obtained only in two-third of the patients, the rest developed neurological manifestations after early operation. The authors have reported that the albumin therapy is more effective for the prevention and the treatment of symptomatic vasospasm than ordinary measures. Based upon this result, the effectiveness of early operation followed by albumin therapy for the severe SAH in order to prevent and treat the later complications of vasospasm were analyzed in this report.<BR>For the last 4 years, 45 patients with severe SAH as classified to the Group 3 after Fisher, were operated within 4 days after the onset and were followed by albumin therapy prophilactily. Numbers of their grade (after Hunt & Kosnik), grade 1 & 2, 3, 4, 5 were as follows; 17, 17, 10, 1 respectively. Operative procedure was carried out by the trans-sylvian approach (32 cases) or trans-interhemispheric approach (13 cases). After the operation, albumin therapy was begun with the initial dose of 1.0g/kg/day. In case that neurological manifestation developed, the dose of albumin was increased to 1.5-2.5g/kg/day.<BR>7 died and the morbidity rates of good recovery, moderately disabled, severely disabled and persistent vegetative state (after Glasgow Outcome Scale) were as follows; 33/45 (69.8%), 2/45 (4.4%), 3/45 (6.7%) and 2/45 (4.4%) respectively. The result for the prevention of symptomatic vasospasm with the initial dose of albumin administration, only 5 patients (11.1%) out of 45 developed symptomatic vasospasm. Among these 5 patients, 3 patients recovered completely, only 2 patients (4.4%) were resisted to this measures.<BR>It could be said that this measure is the most valuable for prevention and treatment of symptomatic vasospasm in patients with severe SAH.

• The Japanese Society on Surgery for Cerebral Strokeの論文

著者

• 遠藤 昌孝

  北里大学脳神経外科

• 大和田 隆

  北里大学脳神経外科

• 矢田 賢三

  北里大学脳神経外科学

• 田辺 貴丸

  北里大学脳神経外科

• 酒井 英光

  北里大学脳神経外科

• 伊藤 比呂志

  北里大学脳神経外科

• 矢田 賢三

  北里大学脳神経外科

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