Treatment for Ruptured Aneurysm in Acute Phase

In acute phase of ruptured aneurysm for patients in Grade III with uphill course, elective operation was done after getting better conditions, and for patients in Grade III with downhill course or in Grade IV, operation was performed immediately when vital signs were allowable. Anti-hypertensive agents were given to all patients in acute phase. But diastolic hypertension which was over 110 mmHg was brought down lower than 90 mmHg. When patients were old, arteriosclerotic, cerebrovasospastic, and showed systolic hypertension over 160 mmHg, blood pressure was reduced to 20 percent. Local application of papaverine to spastic cerebral artery at operation was performed, and excellent cerebral vasodilation was obtained in 7 of 12 cases. ECG changes associated with subarachnoid hemorrhage are ST-segment displacement, T-wave changes and ST-interval changes. However myocardial infarction should be ruled out by serial ECG, SGOT and SCPK. 24g of EACA was administered to 14 cases intravenously or orally. But one of them rebleeded before operation. Anti-fibrinolytic agents were thought to increase the incidence of ischemic cerebral infarction. Therefore following experiment was undertaken. Method; 98 S.D.-Rats were devided into EACA-Heparin, EACA and control group. An arterial sac was created by ligating the abdominal aorta. Autopsy was done at 4th day, 9th day and 14th day after ligation. EACA was administered orally 0.8g/kg/day from one day before ligation and heparin was injected subcutaneously 800u/ kg at 1st, and then following 400u/kg every 12 hours. Results. 1. EACA was considered to play a significant role on preserving thrombus weight. 2. The side effect of heparin (bleeding and hematoma) was not recognized in this study. 3. The fibrinolysis of cerebral artery was four times as much as that of abdominal aorta. 4. In EACA-Heparin group, antifibrinolytic as well as anti-coagulant action of either agent seemed to be well preserved. Thrombus weight of this group on 4th day after ligation was two or three times as much as the other group, but its significance was not known.