脳代謝サイクルの中問代謝物質による頭部外傷の治療—第1報：CDP-Cholineの使用

TREATMENT ON HEAD INJURIES WITH INTERMEDIATE SUBSTANCES OF METABOLIC CYCLE OF BRAIN:Citidine diphosphate choline

I．緒言

　頭部外傷，脳手術術後に見られるさまざまな症状のなかで意識障害が重要な症状であることは疑いのないところである。臨床的に意識障害の程度，持続時間などを考えるとき，一次的脳損傷による障害の他に，二次的に脳損傷を発生して意識障害を強め，また意識の回復を遷延せしめる要素として，脳浮腫，頭蓋内血腫，脳循環障害，過高熱などがあり，これらに伴う脳の水分，電解質の代謝異常，脳内エネルギー代謝の異常などの存在が考えられる。

　従つて，意識障害はその発生の主役を演じている原因により，いろいろの形に分類され，その治療方針もそれぞれの原因，形状に即して適切に処置されねばならない。

Recently it is carefully observed that the thera-peutic effect with intermediate of metabolism of the brain is remarkable in some cases of brain injury. The authors looked at citidine diphosphate choline (CDP-choline) as substance relating to fat metabolism of the brain, especially to bio-synthesis of lecithin, observed and discussed about its clinical use.

The results of basic experiment are as follows:

1) According to EEG and clinical findings, it shows good effect of awakening in cases of sleepness being induced by chloral hydrate. 2) It shows no abnormal activating effect of EEG in epileptics in supporsing closis (200~300mg).

In clinical experiment we used CDP-choline in 22 cases of disturbance of consciousness and observed those clinical courses. Conclusions are as follows: 1) In the period of prolonged conscious disturbance of posttraumatic or postoperative condition, CDP-choline shows remarkable effect in clinical courses of 10 cases. 2) It is not effective to the organic cerebral lesions, but effective to cases considered as the functional disorders affected by cerebral lesions. 3) Any remarkable side effect cannot be found in all our cases, that are administrated 200mg/day of CDP-choline by intravenous of intramuscular injec-tion continuously for 20 days or more. 4) It is considered that the better effects are obtained by using Vitamine B₁, GABA, ATP, Cytochrome C and so on together.

CDP-choline is triable to therapeutics of distur-bance of consciousness because of its least side effect and its occasionally successful results. But on most acute stages of primary damage of the brain it is more important to avoid the more organic cerebral lesions by means of other known methods such as operation, hypothermia and anti-swelling therapies.