뇌지주막하 출혈 후 중증 불응성 뇌혈관 연축에 대한 바비튜레이트 혼수요법

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.<BR> 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.<BR> 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%.<BR> 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.