본문 바로가기
KERD
논문KCI 등재

파열 동맥류 환자에서 과혈량 대 정상혈량 치료

Hypervolemic Versus Normovolemic Therapy in Patients with Ruptured Cerebral Aneurysm

김요식|강성돈
대한신경과학회 (Korean Neurological Association)|2006.08|대한신경과학회지 (Journal of the Korean Neurological Association)|제24권 제4호|pp. 323-327

2

조회

0

다운로드

0

인용

0

참고문헌

주제분류신경과학

초록

Abstract

Background: Postoperative triple H therapy is regarded as a mainstay for prophylaxis and treatment of delayed ischemic neurologic deficit (DIND) after subarachnoid hemorrhage (SAH). However, there are doubts about its effectiveness. This study was performed to assess hypervolemic dynamic fluid therapy in patients with ruptured cerebral aneurysms. Methods: The authors retrospectively studied a total of 393 patients with ruptured cerebral aneurysms, consisting of early surgery with or without intraoperative ventriculostomy during a recent 5 year period (July 1998~June 2003). Hypervolemic dynamic fluid therapy was initiated postoperatively in patients with DIND. Since January 2001, however, patients were maintained in normovolemia and normotension, and when DIND had manifested, low molecular weight dextran was only added. The incidence of DIND and outcome according to Glasgow Outcome Scale at 6 months of the normovolemic group were compared with the hypervolemic group. All patients were followed for at least 14 days after the admission including clinical assessment, TCD recording, CT scanning, CVP measurements, and nimodipine infusion. Results: Subjects in the two treatment groups were similar with regard to age, sex, Fisher grade, Hunt-Hess grade, aneurysm location, and aneurysm size. No differences were found between the two groups regarding the incidence of DIND (29/182: 15.9% vs 29/211: 13.7%). Surgical outcome in the normovolemic group (good, 171/211: 81.0%) was comparable to the hypervolemic group (good, 154/182: 84.6%). Conclusions: Although careful fluid management to avoid hypovolemia may reduce the risk of DIND after SAH, prophylactic hypervolemic dynamic fluid therapy is unlikely to confer an additional benefit.

참고문헌 (21)

  1. "Clinical vasospasm after subarachnoid hemorrhage:response to hypervolemic hemodilution and arterial hypertensin", 18, pp.365~372 (1987)
  2. "Observations on the perioperative management of aneurysmal subarachnoid hemorrhage", 65, pp.48~62 (1986)
  3. "Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension", 11, pp.337~343 (1982)
  4. "Early aneurysm surgery and prophylactic hypervolemic hypertensive therapy for the treatment of aneurysmal subarachnoid hemorrhage", 23, pp.699~704 (1988)
  5. "Effect of hypervolemic therapy on cerebral blood flow after subarachnoid hemorrhage:a randomized controlled trial", 31, pp.383~391 (2000)
  6. "Prophylactic hypervolemia without calcium channel blockers in early aneurysm surgery", 30, pp.12~16 (1992)
  7. "Early aneurysm surgery and dehydration therapy in patients with severe subarachnoid haemorrhage without ICH", 138, pp.1050~1056 (1996)
  8. "Transcrainal Doppler ultrasound in hypertensive versus normotensive patients after aneurysmal subarachnoid haemorrhage", 26, pp.2071~2074 (1995)
  9. "Cerebral vasospasm diagnosis by means of angiography and blood velocity measurements", 100, pp.12~24 (1989)
  10. "Nonopereative treatment of aneurysmal subarachnoid hemorrhage", 3, pp.1264~1271 (1996), WB Saunders
  11. "Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning", 6, pp.1~9 (1980)
  12. "Surgical risk as related to time of intervention in the repair of intracranial aneurysms", 28, pp.14~20 (1968)
  13. "Hematocrit,blood viscosity and plasma viscosity in patients with aneurysmal subarachnoid hemorrhage", 19, pp.530~539 (1990)
  14. "Control of hypertension and prophylaxis against vasospasm in cases of subarachnoid hemorrhage:a preliminary report", 12, pp.658~661 (1983)
  15. "Impairment of cerebral autoregulation during the development of chronic cerebral vasospasm after subarachnoid hemorrhage in primates", 28, pp.41~48 (1991)
  16. "Hemorheological and hemodynamic analysis of hypervolemic hemodilution therapy for cerebral vasospasm after aneurysmal subarachnoid hemorrhage", 26, pp.1620~1626 (1995)
  17. "Cerebral vasospasm with ruptured saccular aneurysm-the clinical manifestations", 1, pp.245~248 (1977)
  18. "Time course of vasospasm in man", 48, pp.173~178 (1978)
  19. "Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the multicenter cooperative aneurysm study", 23, pp.1007~1017 (1995)
  20. "Effect of 5% albumin solution on sodium balance and blood volume after subarachnoid hemorrhage", 42, pp.759~768 (1998)
  21. "A recent 6-year review of good grade patients with aneurysm surgery:surgery outcome and its contributing factors", 25, pp.2478~2483 (1996)

관련 논문AI추천

뇌동맥류 파열에 의한 지주막하 출혈 환자에서의 수술 후 항경련제의 효과김영진, 전민호대한재활의학회 · Annals of Rehabilitation Medicine2003 · 제27권 제6호지주막하 출혈에 따른 Vasospasm에 대한 Transcranial Doppler의 임상적 적용이준홍대한임상신경생리학회 · Annals of Clinical Neurophysiology1999 · 제1권 제1호뇌동맥류 조기 재출혈을 보인 환자에서 수술 전 두개내압 감소로 인한 국소 신경학적 손상 역전김환희, 나효석, 도상환, 박상현, 박희평, 이상철, 전영태대한중환자의학회 · Acute and Critical Care2008 · 제23권 제1호항혈소판제 치료로 호전된 두개내추골동맥 박리동맥류 2예김규식, 이준홍, 정요한, 조정희, 최선아대한신경과학회 · 대한신경과학회지2007 · 제25권 제4호혈액장애에 의한 뇌졸중 환자에서 측두동맥-중대뇌동맥문합술이 뇌혈류와 뇌혈관 반응성에 미치는 영향강성돈, 김요식, 이학승대한신경과학회 · 대한신경과학회지2002 · 제20권 제5호파열 된 뇌동맥류 목 묶음술에 대한 고찰김동준, 박상구, 한형태대한임상검사과학회 · 대한임상검사과학회지2015 · 제47권 제1호

이 간행물의 다른 논문 (10건)

급성기 뇌경색에서의 Clopidogrel의 저항성차재관, 김재우, 김상호, 전성만pp. 319-323알츠하이머병과 혈관성치매에서의 진행 정도에 따른 임상 양상의 차이최문성, 유봉구, 김응규, 안경숙, 이상찬, 홍태용, 성상민, 손태홍, 김태유, 윤수진, 김수영, 정해관, 김재우, 윤성민, 박경원pp. 337-346선행성 기억상실을 주증상으로 나타낸 신경베체트씨병 1예박민정, 박경원, 김재우, 서정화, 윤고운pp. 367-371양측 전장에 간질 병소를 보인 간질중첩으로 발현한 섬엽간질 1예김지윤, 이종두, 원요섭, 김응엽, 박수철, 박형준, 박해정pp. 372-377의식 장애를 동반한 뇌척수액 저용적 증후군 1예김예성, 김재문, 최수영, 김대현pp. 378-380
원문 보기