抄録
We reported that the hyperdynamic therapy by the administration of a large amount of albumin was markedly effective for the treatment of symptomatic vasospasm with SAH caused by ruptured aneurysm. Based upon this results, we have attempted to use albumin prophylactically for the prevention of symptomatic vasospasm and obtained an excellent results.
In this report, we are reporting the results of this treatment, the amount and duration of albumin administration that we have used.
During the past two years, twenty five patients who belonged to the Group 3 CT classification of SAH reported by Fisher, in which have a possibility to develop 98% of symptomatic vasospasm, were the subject of this study. Eighteen patients out of 25 underwent an early operation of clipping aneurysm with the evacuation of subarachnoid blood clot and cisternal drainage. In 7 patients out of 25, surgery was intensively delayed by various reasons. After the confirmative CT scan for the diagnosis of SAH in Group 3, albumin 1-2 gm/kg/day were administered venously for 7-14 days in those 25 cases for the prevention of symptomatic vasospasm. Only three patients (16.7%) out of 18 who underwent early operation developed sympathetic vasospasm. Among seven patients whose operations were intentionally delayed, three patients (42.8%) developed symptomatic vasospasm.
Thus, the overall results were only 6 patients (24%) out of 25 developed symptomatic vasospasm. This was a very low incidence of symptomatic vasospasm compared with that of Fisher's report (98%). Analysis of the amount of albumin administration revealed that 1.0±0.3gm/kg/day in symptomatic vasospasm patients, and 1.25±0.3gm/kg/day in non-symptomatic patients. There was a statistically significant difference among those two groups. Five patients out of 6 in symptomatic vasospasm group did developed the neurological manifestations during the gradual decreasing period of albumin administration, 4-9 days after the beginning of this treatment with initial amount of 1.0 gm/kg/day of albumin administration.
It can be speculated that it may be possible to decrease the incidence of symptomatic vasospasm by the adequate amount of albumin administration even in the state of severe SAH during the waiting time for the surgery of the ruptured aneurysm. Moreover the symptomatic vasospasm may be able to be prevented, if the early operation of the clipping of aneurysm were performed with the extensive evacuation of subarachnoid blood clot and cisternal drainage followed by the postoperative hyperdynamic therapy using adequate amount of albumin administration.
