자발상 뇌지주막하출혈 환자에서 뇌실질내혈종의 임상적 의의
Clinical Significance of Intracerebral Hematoma in Patients with Spontaneous Subarachnoid Hemorrhage
소속 상세정보
배학근/Hak Guen Bae
도재원/이경석/윤일규/변박장/Jae Won Doh/Keong Seok Lee/Il Gyu Yun/Bark Jang Byun
KMID : 0359819970260030370
Abstract
결 론
지난 7년간 527례의 뇌주막하출혈 환자 중 115례(21.8%) 뇌실질내혈종을 동반했다. 혈종
의 동반빈도는 연령 50세 이후, 중대뇌동맥류 파열. 내원 당시 HHG가 높을수록 혈종의 발
생 빈도가 높았으며, 혈종을 등반한 환자에서 재출혈 및 뇌실내출혈의 발생 빈도가 높았다.
전대뇌동맥류, 중대뇌동맥류 및 내경동맥류 파열시 혈종의 동반 유무는 사망율에 현저한 영
향을 미쳤으며. 특히 혈종을 동반한 중대뇌동맥류 및 내경동맥류 환자에서 수술후 사망율이.
혈종이 없었던 환자에 비해 3배 이상으로 높았다. 비록 내원 당시 환자의 임상 상태가 예후
를 결정하는 중요한 인자이나, 같은 임상상태라도 혈종을 동반하면 예후는 더욱 불량하다.
혈종을 동반한 환자의 수술후 사망율은 36.4%, 24시간이내 조기수술후 사망율은 60%였다.
혈종량 300㏄이상 되는 환자의 76.5%에서 출혈 24시간 내에 수술받았으며, 수술후 사망율이
64.7%로 매우 높았지만, 생존자의 50%에서 양호한 회복을 보였던 점과 혈종을 동반한 환자
에서 재출혈 발생이 높았다는 점은, 혈종을 동반한 뇌동맥류에 환자에 대한 적극적 조기수
술의 필요성을 강조한다.
#초록#
To investigate the clinical significance of intracerebral hematomal(ICH) in patients
with spontaneous subarachnoid, hemorrhage(SAH), the authors reviewed 527 consecutive
patients with SAH during the past 7 years. Computed tomography(CT) visible ICH was
found in 115 patients(21.8%). In patients over 50 years old. ICH was found more
frequently than patients aged 50 years or less(p<0.05). Patients with ICH had a higher
incidence of intraventicular hemorrhage or rebleeding compared with patients without
ICH(P<0.005). No significant associate was found between pre-existing hypertension and
ICH. Patients with ICH were in higher Hung and Hess Grade(HHG) on
admission(p<0.005), and had a poorer outcome compared with patients without
ICH(p<0.005).
Seventy-nine(20.2%) among the 392 patients with aneurysmal subarachnoid
hemorrhage had ICHs, of whom the frequent site of aneurysm was the middle cerebral
artery on 45.3%, anterior cerebral artery in 17.9%. The rate of 313 good recovery in
these patients was significantly low compared with patients without ICH. The mortality
in 313 operated patients with aneurysmal subarachnoid hemorrhage was 36.4% in
patients with ICH and 14.6% in those without ICH(p<0.005). Particularly, in the patients
with middle cerebral artery or internal carotid artery aneurysm. ICH and a significant
influence on the good recovery and mortality(p<0.005). Even though the surgical
mortality of the patients with large hematoma more than 30 ㏄ in amount was 64.7%,
one half of the survivors showed good recovery. This study suggests that the prognosis
after subarachnoid hemorrhage is poorer in patients with an ICH. Although the initial
clinical grade is an important prognostic factor, the prognosis for patients in the same
initial clinical grade is poorer when ICH is accompanied. In regard with an increased
incidence of rebleeding episode and an increased intracranial pressure in the patients
with ICHs, we emphasize the importance of early surgical intervention.
키워드
Spontaneous subarachnoid hemorrhage; Aneurysm; Intracerebral hematoma.;
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