Full Packed SAH に対するUrokinase 加人工髄液による脳槽灌流法の臨床経験

Abstract

In order to evaluate the usefullness on cisternal irrigation with urokinase (UK) for severe subarachnoid hemorrhage after aneurysm surgery, we defined the “CT score” and select a group of patients designated “Full Packed SAH” who had a CT score of more than eight points. All 22 patients had diffuse thick subarachnoid clots and the mean Hounsfield number of each cistern was 63.92. Early operation (within 48 hours), removal of subarachnoid clots and subsequently UK irrigation for one week were conducted in most of the cases. The use of spinal drainage and intermittent irrigation with UK were useful for efficient clot removal and maintenance of irrigation. Permanent disability or death occured in nine cases (41%) in whom UK irrigation was performed (in particular, symptomatic vasospasm occured in 23%), against 61% in whom UK irrigation was not done. Seven cases died from vasospasm (3 cases), meningitis, other aneurysm rupture, pneumonia, and aneurysm rupture in anesthesia.In conclusion, we evaluate the usefullness of early operation, removal of subarachnoid clots and cisternal irrigation with UK for diffuse severe subarachnoid hemorrhage (“Full Packed SAH”) after aneurysm rupture.