破裂脳動脈瘤例の入院中の再破裂について

RERUPTURING OF RUPTURED INTRACRANIAL ANEURYSM DURING HOSPITALIZATION

I．はじめに

　破裂脳動脈瘤の多くの症例は，初回発作後再破裂発作を繰り返し死の転帰をとる。この再破裂発作を防ぐことのできる治療法として，外科的根治手術が最近では一般的となつてきた。しかし，患者の入院時期，諸検査あるいは病院の手術体制によつて，根治手術の目的で入院したにもかかわらず，待機中に再破裂発作に襲われ，重篤となり救命できなくなる症例も少なくない。

　先に我々は，脳動脈瘤の再発作の時期および型について，その既往を詳細に検討し，興味ある法則性のあることを報告してきたが^6），脳神経外科という特殊な環境に入院中では，やや異なるものがあるのではないかと考え，さらに，諸記録が充実していることをも合わせて，入院中再破裂ということにまとをしぼり種々の検討を行なつた。

From the 1080 patients ot saccular aneurysms experienced in our clinic from 1965 to 1975, thirty-six hospitalized patients incurring rebleeding prior to radical surgery were selected to discuss the factors of rebleeding. Infarction cases definitely attributed to cerebral vasospasms were excluded from this investigation.

This study revealed:(1) Within five days after admission, rebleeding occurred in 28 of the 36 patients including eight cases on the day of ad-mission. One month after the first attack, the incidence of rebleeding generally decreases. How-ever, three of such patients experienced rebleeding within five days after admission. The above men-tioned factors may indicate that stress of hospitaliz-ation especially in a neurosurgical clinic may in-fluence rebleeding.(2) Only 27 of the 36 cases were in agreement with our preliminary report on the prediction of the rebleeding time based on con-sciousness levels at the first attack. In the latter nine cases, the discrepency is attributed to the enormous pressures prior to neurosurgery and un-usual characteristics of the bleeding focus.(3) In the majority of the cases, rebleeding occurred dur-ing random activities between 6 a. m. and 9 p. m.. (4) The incidence of rebleeding was high in patients with clear consciousness and those in which con-sciousness were improving.(5) Although the blood pressures in only three of 11 patients were above 150 mmHg one hour before rebleeding both mental and physical stresses prior to neurosurgery is con-sidered a major factor of rebleeding.(6) Increased frequencies of headaches and manifestation of psychic disorders commonly precede rebleeding.