뇌지주막하 출혈 후 중증 불응성 뇌혈관 연축에 대한 바비튜레이트 혼수요법

• Published in: Journal of Korean Neurosurgical Society pp. 142 - 148
• Main Authors: 허동화, 허철, 조성민, 황금, 변진수, 김헌주
• Format: Journal Article
• Language: Korean
• Published: 대한신경외과학회 01.02.2003
• Subjects: 신경외과학
• ISSN: 2005-3711; 1598-7876

Objective：This study is designed to evaluate the therapeutic effects and prognostic factors for barbituate coma therapy(BCT)in severe and refractory vasospasm following subarachnoid hemorrhage. Methods：Barbiturate coma therapy was used in 18 patients with severe and refractory vasospasm in spite of "3-H therapy" and intra-arterial papaverine infusion. The authors analyzed the clinical parameters including Glasgow Coma Scale(GCS), electroenceplographic finding, and brain computerized tomography(CT) scan findings in relation to outcome at discharge. Results：Among 18 patients, burst suppression pattern could be obtained in 17. In cases with good outcome, the duration elapsed from coma to drowsiness after BCT was 14.09±5.82 days and GCS score at this time was significant in the prediction of final outcome(p<0.05). Patients with ideal burst suppression pattern attainable more than 24 to 48 hours showed good outcome in 81.8%(p<0.05). The group that showed focal low density in the brain CT scan taken before BCT fared better prognosis compared with that of multifocal or diffuse low density(p<0.05), and patients with resolution of perimesencephalic cistern effacement on follow-up brain CT scan taken 48 hours after BCT showed better prognosis(p<0.05). Overall, 72.2% showed improvement of GCS score by 2 or more, and good outcome was noted in 50%. Conclusion：The barbiturate coma therapy seems to have a beneficial therapeutic effect on severe and refractory vasospasm and can be considered as a useful therapeutic modality. Key words:Subarachnoid hemorrhage;Vasospasm;Barbiturate coma therapy. KCI Citation Count: 1