脳動脈瘤破裂による重症くも膜下出血の発生に関与する因子（Risk Factors）の検討

Risk Factors for Severe Subarachnoid Hemorrhage Following Aneurysmal Rupture

I．はじめに

　脳動脈瘤の手術成績は，microsurgeryの導入，手術アプローチの．改良及び急性期手術の普及により飛躍的に向上したが，動脈瘤破裂による重症くも膜下出血例の手術成績は，くも膜下出血による直接的脳損傷や，術後に発生する脳血管攣縮のため尚満足すべきものではない．今回脳動脈瘤患者の手術成績を向上させるためには，重症のくも膜下出血の発生を未然に予防することが重要であるとの観点から，その発生に関与すると考えられる危険因子（risk factors）と，重症くも膜下出血患者の予後に影響を及ぼす危険因子について自験例81例において検討を加えた．

Major reduction in disability and death from severe subarachnoid hemorrhage (SAH) can probably be brought about more effectively by prevention than by better medical or surgical treatment. Identification of the major risk factors for severe SAH should facilitate the preventive efforts. As risk factors for severe SAH, a pa-tient's age, sex, location and size of aneurysms, hyperten-sion, rebleeding including minor leak, and cigarette smoking were selected. The relation between the inci-dence of severe SAH, a surgical results, and the risk fac-tors was examined in 81 severe SAH cases. Hyperten-sion, rebleecling from aneurysms, large aneurysm ex-ceeding 1.0cm/sec in size were closely connected to se-vere SAH. Treatment of hypertension, acute surgery for aneurysms and aggressive surgery for unruptured large aneurysms were the only hope for achieving substantial reduction in the incidence of severe SAH and for impro-ving the surgical results.