Akinetic Mutism, Apallic Syndromeなどの外傷性遷延昏睡に対する治療上の1試み—頸動脈内椎骨動脈内血液衝撃注入法（Preliminary note）

A FORCEFUL INTRACAROTID, INTRAVERTEBRAI. ARTERIAL INJECTION OF BLOOD FOR PROLONGED POSTTRAUMATIC COMA

Ｉ．はじめに

　現今，医学のめざましい進歩によって，当然早急に不幸の転帰をとるであろうと思われた重症頭部外傷患者が生と死の間にsuspendingの状態で生きながらえているような場合が増加してきた。患者の栄養管理，感染褥創などの合併症防止などが十分に行なわれるならば長期間生存しうる。しかし，外傷直撃，二次的損傷によつて脳損傷がひどいときは，"完全な意識"は容易に回復しない。vigilance of consciousnessは存在しても，activityof consciousness,content of consciousnessとが失われた^13）vegetative Stateである。

　しかも，かかる状態は疾患の悪化を容易に招き^13）21），看護側にとつても，患家にとちても，けつして予断を許さないものである。したがつて可及的早急に，この状態から脱出させなければならない。すなわち，"完全な意識"を回復させることである。当科で用いられるすべての方法を駆使してもなお，完全な意識の回復を示さなかつた外傷性遷延昏睡症に対して，患家の完全な同意を得た後，笹部は頸動脈内，椎骨動脈内血液衝撃注入法ともいうべき方法を治療として試みた。症例は少数であり，今後検討すべき多くの問題点を残してはいるが，本法が自家症例に対して効果があったと思うので，preliminarynoteとして報告し，あわせて外傷性遷延昏睡^30）の概略と，その経過の模式図について，一私見を加えてみたい。

Along with a recent remarkable medical progress, severe head injury victims suspending between life and death are distinctly on the increase. If a careful administration is done for maintenance of good nu-lrition, for prevention of infection, decubitus and other complications, these patients may live for a tong time as a vegetative state. When the brain, however, is damaged with a primary or a secondarylesion, complete consciousness would not appear with ease. The state has often been referred to as coma vigil, akinetic mutism, or prolonged post-traumatic coma.

Deterioration would frequently be encountered, and that is characteristic of the state. The state may embarrass the patient's family as well as a nursing team. It is demanded, therefore, that the patient's complete consciousness be regained as soon as possible. The present note is to show how to get full consciousness from such a situation.

From March 1968 to April 1969, such patients were transferred to our department. Two of them had severe cerebral contusions ; a third, open multiple depressed fracture with dura torn of the left vault followed by brain abscess ; the other, subdural hematoma. For these patients, a forceful intracarotid, intravertebral arterial injections of blood (100 ml per day), after attacking this state from every angle, was performed as a treatment. Sufficient results were obtained from three cases except one who had already developed brain abscess prior to the start of this method. The method has been explained in this article.