破裂脳動脈瘤急性期手術症例におけるTXA<SUB>2</SUB>合成阻害剤の臨床経過と脳血流量に及ぼす影響

Abstract

Effect of thromboxane A2 synthetase inhibitor (sodium ozagrel) on development of symptomatic vasospasm and on discharge outcome was studied in 16 patients with ruptured aneurysm (sodium ozagrel group) in comparison with another 46 patients without the drug (control group). Cerebral blood flow (CBF) was also measured sequentially in 6 patients of the former group. In the first group, six patients were classified group 1 or 2 of Fisher's CT scan classification of subarachnoid hematoma volume and 10 patients were classified group 3 or 4; 19 patients were classified group 1 or 2 and 27 patients were classified group 3 or 4 in the latter group. All these patients were surgically treated within 72 hours of onset. In the patients of group 1 or 2, no one of the sodium ozagrel group developed a symptomatic vasospasm and all of them had an excellent outcome on discharge. Six of 19 patients of the control group developed a symptomatic vasospasm, and 17 patients had an excellent outcome and 2 patients had a good outcome. In the patients of group 3 or 4, 6 out of 10 patients of the sodium ozagrel group developed a symptomatic vasospasm, and 7 patients had an excellent or good outcome on discharge and 3 patients had a fair or poor outcome. No patient died. Seventeen of 27 patients of the control group developed a symptomatic vasospasm, and 16 patients had an excellent or good outcome, 9 patients had a fair or poor outcome and 2 patients died. CBF was reduced temporarily in the area of the parent artery of the aneurysm in the patients who had an excellent clinical course. On the contrary, CBF reduction was diffuse and long-standing in the patient who developed a symptomatic vasospasm and subsequently a normal pressure hydrocephalus. From these findings, it is concluded that sodium ozagrel is effective in mild cases of subarachnoid hemorrhage, but its efficacy is limited in severe cases. The drug is to improve a microcirculatory disturbance secondary to vasospasm.