慢性腎不全患者に発症した出血性脳血管障害の周術期管理 腹部手術の既往を有する症例の場合

• Published in: 脳卒中の外科 Vol. 28; no. 5; pp. 393 - 396
• Main Authors: 北原, 哲博, 武田, 洋子, 富永, 貴志, 伊藤, 治英, 師井, 淳太, 出口, 誠, 副島, 由行, 立石, 彰男, 秋村, 龍夫, 柏木, 史郎, 山下, 勝弘
• Format: Journal Article
• Language: Japanese
• Published: 一般社団法人 日本脳卒中の外科学会 30.09.2000
• Subjects: chronic renal failure; continuous hemodiafiltration; continuous hemofiltration; intracerebral hemorrhage; subarachnoid hemorrhage
• ISSN: 0914-5508; 1880-4683
• DOI: 10.2335/scs1987.28.5_393

We describe the use of continuous hemofiltration (CHF) or continuous hemodiafiltration (CHDF) in 2 perioperative patients with chronic renal failure (CRF) who suffered from intracranial hemorrhage. Because of previous abdominal surgery, continuous ambulatory peritoneal dialysis (CAPD) was not indicated for them. A 51-year-old female with CRF suffered from subarachnoid hemorrhage. She presented with severe metabolic acidosis that was uncontrollable by washout therapy. CHF improved her severe acidosis without hemodynamic instability, and then she was successfully operated on under general anesthesia. A 69-year-old female with hemodialysis-dependent CRF suffered from right putaminal hemorrhage with ventricular hemorrhage. The patient presented with hyperkalemia and severe hypertension due to water excess on admission. After stereotactic aspiration of the hematoma, CHDF was performed to control water balance and to prevent exacerbation of uremia. During CHDF, the patient developed no symptoms of increased ICP or hemodynamic instability. Our experience of these 2 cases suggests that CHF and CHDF provide excellent fluid and mineral controls in the perioperative management of the patients with intracranial hemorrhage without increasing ICP or the risk of bleeding.