重症くも膜下出血患者の血管攣縮期輸液管理におけるPiCCO(連続心拍出量測定装置)の有用性と問題点  [in Japanese] Usefulness of PiCCO in the Management of Patients with Delayed Vasospasm after Subarachnoid Hemorrhage : From a Viewpoint of Systemic Cardiovascular Hemodynamics  [in Japanese]

Before the PiCCO system became available, patients with delayed vasospasm were treated in order to control circulating blood volume from the viewpoint of several systemic factors associated with pressure such as central venous pressure, pulmonary arterial wedged pressure, etc. Since, however, these factors are well-known to not always reflect the circulating blood volume, excessive intravenous administration induces over-hydration in patients who are either aged and/or are experiencing symptomatic vasospasm, leading to serious conditions such as pulmonary edema and cardiac failure. The PiCCO system has enabled us to treat patients with symptomatic vasospasm by more precisely estimating circulating hemodynamics. Taking into account the data obtained from the PiCCO system, we discuss its advantages and disadvantages. Out of patients who underwent acute surgery from June 2006 to May 2007, a total of 18 patients with Fisher 3 in CT grading of SAH who were thought to be likely to suffer from cardiac failure or pulmonary edema were selected. The average age was 63.2. The number of patients of preoperative Hunt and Kosnik Grade II, III, IV and V was 3, 10, 3 and 2, respectively. Angiographic vasospasm was revealed in 10 patients, 7 of whom were symptomatic. The in- and out-put control in these 18 patients was executed using the PiCCO system. None snowed clinical symptoms associated with cardiac failure or pulmonary edema. We conclude that the PiCCO system is very useful to control the systemic hemodynamics in the treatment of patients with delayed vasospasm.