[Combination therapy (hypervolemia, Fluosol-DA 20%, hypertension) in the treatment of symptomatic vasospasm]

Combination therapy of (1) hypervolemia with albumin (1 g/kg/day), (2) artificial blood substitute (Fluosol-DA 20%, 10 ml/kg/day) and (3) induced hypertension was performed for the treatment of symptomatic vasospasm. Outcome was compared between thus treated patients (Treated group) and those without specific treatment (Non-treated group) in (1) 30 patients presenting with vasospasm who were planned to undergo delayed operation (Delayed operation group), (2) 23 patients undergoing early operation whose subarachnoid hemorrhage (DAH) was in group 2 according to Fisher's classification (Fisher Group-2) and (3) 25 patients undergoing early operation whose SAH was in group 3 (Fisher Group-3). In delayed operation group, the combination therapy improves the outcome to some extent resulting in increase of "Excellent" and "Good" patient from the rate of 25% to 35% (Table 1). Vasospasm appears at a low rate of 26% as well as in mild degree in Fisher Group-2 regardless of the treatment, which contributes to the satisfactory result observed in this group (Table 2). The outcome of the treated group in Fisher Group-3 is proved to be fairly good with "Excellent" and "Good" patient rate of 70% (Table 3), which seems largely to be attributed to the prophylactic effect of hypervolemia on vasospasm (Table 4). From these results, the combination therapy is considered to be performed with relatively small load on cardiovascular system compared with conventional hypervolemia-hypertension therapy.