慢性腎不全患者における被殻出血の検討

Management of Putaminal Hemorrhage in Patients with Chronic Renal Failure

I．はじめに

　近年，技術や患者管理法の進歩により血液透析患者の長期生存が可能になっている^7）．これに伴い血液透析患者に発症する他疾患の合併も問題になっている．合併症の中には外科治療を必要とするものもあるが，現在では全身状態や諸検査成績が一定の条件を満たせば手術を行うのが一般的見解である^8,10）．血液透析患者の死亡原因の第2位が脳血管障害であることを考えると^7），脳神経外科的には脳内血腫が問題になる．しかし血液透析患者の脳内血腫に対する治療及びその治療成績はいまだ明確でない．

　今回，われわれは2つの施設（筑波メディカルセンター病院：TMC，茨城西南医療センター病院：SMC）に他施設から紹介された慢性腎不全治療中の脳内血腫患者とSMCで慢性腎不全治療中に発症した脳内血腫患者のうち被殻出血（以後PH）に関してその治療成績をまとめ一般的高血圧性脳内血腫（被殻出血）の治療成績と比較してre-trospectiveに検討した．

The treatments of putaminal hemorrhages (PH) were evaluated in 14 patients (15 hematomas) withchronic renal failure (CRF). We compared the data of our series with the data of co-operative study (1990)on PH. With regard to consciousness level (Neurological Grading, NG) and hematoma volume, significant-ly more serious cases were observed in PH with CRF than in PH of the co-operative study. In PH withCRF, mortality (40%) was significantly higher than that in PH of the co-operative study. However, themortality rate was 0%, 0%, 20%, and 100% in NG1, 2, 3, and over 4b. The mortality rate was 0% innon-sur-gically treated cases with 0 to 30ml of hematoma volume, and 0% in surgically treated cases with 10to50ml of hematoma volume. These mortality rates were equal to those of the co-operative study with thesame NG, and equal to those of the co-operative study with the same hematoma volume. With respect tofunctional prognosis, “good” (ADL1 and 2) resulted in 67% of non-surgically treated cases with NG1 to2,and in 33% of surgically treated cases with NG3 to 4a. “Good” resulted in 33% of non-surgically treatedcases with 0 to 30ml of hematoma volume, and in 40% of surgically treated cases with 10 to 50m/ of hema-toma volume. These morbidity rates were equal to those of the co-operative study with the same NG,andequal to those of the co-operative study with the same hematoma volume. Therefore, the high mortalityinPH with CRF was suspected to be due to the fact that, in our study, there was a higher distributionof se-rious cases. These findings indicate that protection against enlargement of hematomas in the acute phasemay bring about improvement of prognosis in PH with CRF.