Hypervolemia Hypertension療法における循環動態モニタリングによる治療目標設定の有用性

概要

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Symptomatic vasospasm (SVS) is an important factor that determines the outcome of patients undergoing early surgical intervention for ruptured aneurysm. We have been dealing with patients who showed SVS progressing despite of mild hypervolemic and/or hypertensive therapy by placing them on further aggressive hyperdynamic therapy using systemic vasodilator which is expected to dilate capacitance vessels. Twenty-five consecutive cases out of 161 patients undergoing early operation within 48 hours after aneurysmal rupture were studied and showed significantly better outcome than that of control group especially as to those at lower (IIIb+IV) grade preoperatively. <BR>Changes of cardiac output (CO) and circulating blood volume (CBV) were studied to know the provisional goal of this aggressive therapy. Forty-five% increase of CO and 18% of CBV were found to give a satisfactory result. These figures, 45% of CO and 18% of CBV, were just the average increase rate of those two parameters of 25 cases studied, and thought to be obtainable easily and safely.
The Japanese Society on Surgery for Cerebral Strokeの論文