뇌동맥류 파열의 계절적, 주간적 변동과 소인 인자

Abstract

In order to determine the predisposing factors to cerebral aneurysm rupture and to examine the relationship between circadian periodicity of blood pressure change and the rupture of an aneurysm. the authors investigated activities of the patients or events as well as diurnal and seasonal variations in the onset of subarachnoid hemorrhage(SAH) in 766 consecutive patients. The authors also compared the difference of these data between patients with a history of hypertension and patients without a history of hypertension. The results showed that the onset of SAH was associated with defecation and/or urination in 12.3%, working on the jab in 11. 8%, housework including washing clothes in 10.3%, sleeping in 7.4% and bathing and/or washing up in 7.2%. The incidence of the onset of SAH associated with defecation and/or urination was higher in patients with a history of hypertension than in patients without a history of hypertension(p<0.05). The diurnal variation of the onset of SAH showed two broad peak times from 6 to 10 a.m. (21.8%) and from 5 to 8 p.m. (18. 3%). The seasonal variation of the onset of SAH showed the incidence to be slightly higher in winter than in any other seasons. In spring. autumn and winter, the leading activities of the patients or events in the onset of SAH was defecation and/or urination and, in summer, it was job performing. We concluded that the onset of the SAH is related not only to the physiological circadian periodicity of blood pressure change but also to the activities or events which induced a sharp rising blood pressure and changing the venous and cerebrospinal fluid pressure.

본원에 입원하였던 766례의 뇌지주막하 출혈 환자를 대상으로 뇌지주막하 출혈의 소인 인자와 계절적, 주간적 변동을 조사하였다. 주도적 소인인자로써는 배변 및 배뇨가 12.3%, 직업적 일을 하다가 11.8%, 가사일을 하다가 10.3%였고, 하루 중 오전 6시부터 10시까지가 21.8%, 오후 5시부터 8시까지에 18.3%가 출혈하였으며, 계절적으로는 겨울에 호발하였으나 다른 계절과 비교하여 통계학적으로 유의한 차이는 없었다. 결론적으로 뇌지주막하 출혈은 혈압의 주간적 생리적 변동에 영향은 받으나 이 이외에도 혈압을 갑자기 상승시키는 활동이나 뇌압에 영향을 미치는 일들도 뇌동맥류 파열에 중요한 역할을 할 것으로 생각된다.