雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 32, Issue 6 （June 2004）

Neurological Surgery 脳神経外科 32巻6号（2004年6月発行）

Japanese English

研究

重症くも膜下出血の治療成績―vasospasmに対する治療の変遷 Differences in Outcome in Patients with Poor Grade Subarachnoid Hemorrhage (WFNS Grade IV and V) : According to the Perioperative Management against Vasospasm 後藤泰伸 ¹ , 山形専 ¹ Yasunobu GOTO ¹ , Sen YAMAGATA ¹ ¹倉敷中央病院脳神経外科 ¹Department of Neurosurgery,Kurashiki Central Hospital キーワード： subarachnoid hemorrhage , vasospasm , cisternal irrigation , milrinone Keyword: subarachnoid hemorrhage , vasospasm , cisternal irrigation , milrinone pp.579-584

発行日 2004年6月1日 Published Date 2004/6/1

DOI https://doi.org/10.11477/mf.1436100398

PDF(84KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

　Ⅰ.はじめに

破裂脳動脈瘤によるくも膜下出血（SAH）の治療はこの10年あまりで大きく変化してきた．顕微鏡手術が進歩してきたことにより急性期のclippingはほとんどの施設で行われるようになった．またGuglielmi Detachable Coil（GDC）による動脈瘤の塞栓術も一般化し，後頭蓋窩の動脈瘤治療の成績はclippingに比肩するほどになっている^3,4,5,10)．脳血管れん縮（vasospasm）に対する輸液，特にバランスや昇圧，希釈などに注意を払うようになったことも，fasudil，ozagrelなどを使用するようになったのもvasospasmの発生率を減らしている^16,18,19)．いったんvasospasmになれば血管形成術（PTA）や塩酸papaverine（PPV）の選択的動脈内投与も行われる^7,8,20)．

　これらによりSAHの治療成績はよくなっているのだろうか．World Federation of Neurological Society（WFNS）gradeのⅠ～Ⅲまでの比較的軽症群では改善していると考えられているが，重症SAH（gradeⅣ，Ⅴ）についてはあまり報告がなく，評価も様々である^{4,6,10,12,17)}．

　Cerebral vasospasm remains a leading cause of morbidity and increasing mortality rates following aneurysmal subarachnoid hemorrhage (SAH). The rate of vasospasm and the outcome (Glasgow Outcome Scale; GOS) especially in poor WFNS grade were retrospectively analyzed over a 6-year period. Patients were divided into three different groups. The first group (pre-group) consisted of 43 patients (grade IV: 31,grade V: 12),who were admitted between 1996 and 1998. When vasospasm occurred,they were mainly treated by papaverine (PPV) and percutaneous transluminal angioplasty (PTA). In the second group (mil-cis group),for the prevention of vasospasm,cisternal irrigation therapy with milrinone was applied in 24 patients (grade IV: 13,grade V: 11),who were admitted in the period between 1999 and 2001. The third group,(w/o mil-cis group),consisted of 30 patients (grade IV: 15,grade V: 15),in whom cisternal irrigation therapy was not able to be carried out.

　In grade IV,vasospasm was observed in 66% of the patients the first group,50% in the w/o mil-cis group and significantly less in the mil-cis group (15%,p＜0.024). In grade V,the rate of vasospasm was also lower in the mil-cis group but no statistical significance was revealed. Although the rate of favorable outcome in GOS was highest and the rate of death was least in the mil-cis group in both grade IV and V,only the trend was observed.

　Many factors should be considered,Cisternal irrigation therapy with milrinone reduced the occurrence of vasospasm. However,outcome was not improved because of the initial poor clinical condition.