(aneurysmal subarachnoid hemorrhage, 17%~60% :SAH. ,asah , 22%~49% : Willis. :1927 Moniz ;(3) 2. ischemic neurological deficit,dind) SAH) SAH ;(6)

Transcription

1 ,, 2. : ;,, :(1), (delayed ;(2) ischemic neurological deficit,dind) ;(3) 2. :SAH ;(4) HT -1-1 ;(5), 10 SAH ;(6) %~50%, ( cerebral vasospasm ) Glasgow (Glasgow Coma Scale,GCS), [1],, (aneurysmal subarachnoid hemorrhage, SAH),aSAH 22%~49%, [7-10] : Willis,,,, 1. :1927 Moniz,1937 Dandy,1951 Ecker, 85%,,,,, SAH 17%~60% [2-6],,, 20%~80% 10%~50% SAH(tSAH)

2 3. :(1), 4 Hess (WFNS) 1 asah;2tsah;3 1 ; 1 4 (2) [13]a 3 :1, Hunt and Hess WFNS [14] Glasgow 15, I ;2 Glasgow II, ;3 Glasgow III (3) Glasgow 7 12, IV 3 : 50% ; Glasgow 25% ~50%; <25% (4) V 3 6 :a ( ) 1 ; 24, 0 I a, 3. :(1) (DSA): (orthogonal polarization spectral imaging),, 2003,aSAH SAH ( ) 50%, [15] 75% [11], (2) SAH 3~5 TCD 7~10 2~3 [12] 1. :(1) : TCD, (2) : TCD, SAH 3~5, d,, ( ),CT (3)CT:CT 12h SAH, CT : asah, Hunt and (TCD) :TCD > 200cm/s ( ) >120cm/s SAH

3 SAH CT asah tsah CT, 7d CT (5) 50% CT (HCT< 30%),CT SAH 24h CT ( ) Fisher [16] 2 (4)CTA MRA: CT CTA CT ( CTA), A1,, 2 Fisher CT 1. : asah asah, % SAH!"# $ 57 4 % & () 57 (6) 2. : SAH, SAH, SAH,,, 3. : (1) :,, DSA TCD CTA, 2007 Cochrane, asah, [17], SAH 3~5 2~3, (AHA) [18] [19] [20] asah 4 (1) TCD, :, : 1 (2) TCD :asah :,, J Neurosurg,aSAH (3) [21] TCD, 2006 (4) Neurosurg Rev

4 asah [22],2007 Neurosurgery 1d [23] 2 4. : : asah 2~3, : 14~21d Youmans Neurological Surgery 5,,60% ~ 80% 21d [24] 14d 3 :, 70kg : 0.5mg/h,2h 1mg/ h; 70kg : 1mg/h,2h 2mg/h 24~ 3H 48mg 1.5h 60mg, 4 h 1 4 :2007 Cochrane,, [17] asah 140 ~ 200 mmhg (1 mm Hg=0.133 kpa) [25] 5 [26] : (1:19, (2) / ), 8 ~10, (2) : mmhg, 100~130 cm H 2 O (1 cm H 2 O=0.098 kpa) (3) 10mg/Kg, 30mg 30%~35% kg -1 d -1 3H, (3) : ;, :0.3%,, 100 ml 0.1 ml/s : ;CT ; (4) ; : Rho, SAH (275 SAH ), SAH 2,, 2~ 3 30 mg 30 min, 5. : :(1),,,

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