Oda S, Shimoda M, Shibata M, Sato O, Tsugane R
Department of Neurosurgery, Tokai University School of Medicine.
No Shinkei Geka. 1995 Jun;23(6):503-7.
The incidence of rerupture during the period of delayed ischemic neurological deficit (DIND) was studied in patients with aneurysmal subarachnoid hemorrhage (SAH) before surgical aneurysmal obliteration, and optimal management of DIND for preventing rerupture is discussed. At Tokai University Hospital, 511 patients with SAH were admitted during the 5-year period from 1988 to 1992. Of these, 247 had not undergone obliteration of the aneurysm neck within 3 days after SAH. In this group, 31% (77 patients) developed DIND. Of these 77 patients, 40 were managed with induced hypertension and/or hypervolemic therapy for DIND (25 with both (group 1), 15 with normotensive hypervolemic therapy (group 2)), and 37 did not receive either kind of therapy (group 3). The incidences of rerupture were as follows: all SAH patients: 11.5%; group 1: 48%; group 2: 7%; group 3: 11%. The incidence of rerupture in group 1 was significantly higher than that in the other groups. On the other hand, the favorable outcome rate (excellent and good) was as follows: group 1: 40%; group 2: 73%; group 3: 22%. This rate was significantly higher in patients who received normotensive hypervolemic therapy, than in other groups. This study suggests that, to avoid rerupture and unfavorable outcome, normotensive hypervolemic therapy is the optimal management approach in patients with DIND after SAH who have not undergone obliteration of the aneurysmal neck.
在手术夹闭动脉瘤之前，对动脉瘤性蛛网膜下腔出血（SAH）患者延迟性缺血性神经功能缺损（DIND）期间再破裂的发生率进行了研究，并讨论了预防再破裂的DIND的最佳管理方法。在东海大学医院，1988年至1992年的5年期间收治了511例SAH患者。其中，247例在SAH后3天内未进行动脉瘤颈夹闭。在该组中，31%（77例）发生了DIND。在这77例患者中，40例采用诱导性高血压和/或高血容量疗法治疗DIND（25例同时采用两种方法（第1组），15例采用正常血压高血容量疗法（第2组）），37例未接受任何一种疗法（第3组）。再破裂的发生率如下：所有SAH患者：11.5%；第1组：48%；第2组：7%；第3组：11%。第1组的再破裂发生率明显高于其他组。另一方面，良好预后率（优秀和良好）如下：第1组：40%；第2组：73%；第3组：22%。接受正常血压高血容量疗法的患者的这一比率明显高于其他组。这项研究表明，为避免再破裂和不良预后，对于未进行动脉瘤颈夹闭的SAH后DIND患者，正常血压高血容量疗法是最佳的管理方法。
