56. 脳動脈瘤手術後の重症脳血管攣縮に対する高血圧療法

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In order to avoid cerebral infarction, Volume Expansion and Hypertension Therapy (VEHT) was performed to the patients with vasospasm which occured following aneurysmal neck clipping in the acute stage of SAH. When vasospasm was confirmed by postoperative angiography in the patients with motor and/or conscious disturbance, they underwent VEHT for about 10 days until neurological deficits were subsided. Hypertension up to 160-180mmHg in systolic blood pressure was brought by i. v. administration of whole blood and/or serum until central venous pressure elevased to 8-15 cmH2O, and then followed by continuous injection of diluted dopamine to increase systolic blood pressure up to 200mmHg if necessary. Cardiac function was assessed carefully with Swan-Ganz catheter to prevent heart failure. Aquaous pitressin was used to control polyuria induced by volume expansion and dopamine administration. Dextran 40 and Urokinase were used to ameliorate cerebral microcirculation. From Aug. 1980 to Jan. 1982, we performed 26 aneurysmal neck clipping in the acute stage after onset of SAH. Among them, 6 patients showed angiographical evidence of vasospasm associated with neurological dificits. They were treated with VEHT immediately after the onset. Four patients whose worst neurological signs during vasospasm were coma and/or hemiparesis well responded to VEHT and their ADL was "excellent" at discharge. A patient did not respond to VEHT. Another patient to whom VEHT was interrupted by heart failure left hemiparesis. VEHT to the postoperative cerebral vasospasm following aneurysmal neck clipping in the acute stage of SAH is effective as long as cardiac function is examined carefully.

56. 脳動脈瘤手術後の重症脳血管攣縮に対する高血圧療法

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