水分,ナトリウム管理はスパスムを改善したのか? : 当院におけるくも膜下出血管理の変遷  [in Japanese] Does Control of Water and Sodium Balance Improve Cerebral Vasospasm after Subarachnoid Hemorrhage  [in Japanese]

Water and sodium balance is very important in patients with subarachnoid hemorrhage (SAH). We reviewed surgical outcomes with regard to cerebral vasospasm in 92 patients with SAH whose water and sodium balance was differently managed. All patients underwent surgery within 96 hours of the SAH. Water balance was controlled only by fluid in Group 1 (1998.1-1999.4), vasopressin was used to control urine output in Group 2 (1999.5-2000.5), and mineralocorticoids were also used to prevent sodium diuresis in Group 3 (2000.6-2001.12). Anti-inflammatory neuroprotective therapy using indomethacin was also employed in Groups 2 and 3. In Group 2, vasopressin effectively controlled urine volume, but also caused hyponatremia, and the incidence of vasospasm increased especially in patients with Hunt & Kosnik Grade 2. In Group 3, although mineralocorticoids prevented sodium diuresis, and reduced the incidence of hyponatremia and vasospasm in patients with Hunt & Kosnik Grade 2, there was no significant improvement on the Glasgow outcome scale or in the incidence of vasospasm in patients with Hunt & Kosnik Grades 3 and 4. Indomethacin reduced the number of high fever cases, but did not improve surgical outcome. Intravascular infusion of vasodilators or systemic hypothermia may be more effective in improving overall outcomes after SAH, especiallv in severe cases.