高血圧性脳出血の再出血例の検討:その特徴と再発因子について

Recurrent hypertensive intracerebral hemorrhage:characteristics and risk factors

I．はじめに

　高血圧性脳出血の再出血の実態は，必ずしも明らかでなく，再出血について詳細に検討した報告は意外と少ない^{7-9,12,14,16）}．そこでわれわれは，再出血の解明の手がかりを得る目的で，過去18年間の高血圧性脳出血の再出血例について，年齢，性別，入院時重症度，出血部位，再出血パターン，再出血の時期，再出血例と血圧との関係および退院時成績について分析し，再出血例の特徴と再発因子について検討したので報告する．

From January 1978 to December 1995, a total of 269 patients with hyperternsive intracerebral hemorrhage were treated in our institution. We reviewed 23 patients with recurrence to analyze their characteristics and risk factors.

Recurrence rate: The recurrence rate was 8.6%, showing it is not so rare.

Hemorrhagic site: In the first hypertensive in-tracerebral hemorrhage, the hemorrhagic site was puta-minal in 60.9%, subcortex in 13.0%, thalamic in 8.7% and cerebellar in 8.7%. In the second episode, the site was putaminal in 39.1%, thalamic in 34.8%, cerebellar in 13.0%, and subcortex in 8.7%. Therefore, during re-currence, hemorrhage occurred relatively more frequen-tly in the thalamus than in the initial site. Interval to rebleeding: The Interval between the first and second hemorrhage ranged from 2 months to 15 years (average 4 years and 7 months).

Blood pressure and recurrence: In patients in whom hypertensive intracerebral hemorrhage recurred in less than 3 years from the initial hemorrhage, blood pres-sure was well controlled by antihypertensive drugs dur-ing the interval. This indicates that factors other than blood pressure control are concerned in the prevention of recurrence. In patients in whom hemorrhage recur-red 3 years or more after the initial episode, blood pres-sure was poorly controlled, indicating that strict antihy-pertensive therapy is necessary to prevent recurrence after a long interval.

Risk factors for recurrence: The following risk fac-tors for recurrence of hypertensive intracerebral hemor-rhage have been reported in the literature: diastolic blood pressure ≧100mmHg; unstable hypertension (blood pressure abruptly rising from the normal range): uncontrollable hypertension; and hypoprotein-emia. Of these, we emphasize that unstable hyperten-sion is the most important risk factor, as illustrated in our series of patients.