雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

検索

書誌情報 詳細検索 by 医中誌

Japanese

EFFECTS OF NOREPINEPHRINE AND PHENTOLAMINE ON ACUTE INTRACRANIAL HYPERTENSION Minoru Hayashi 1 , Shinobu Marukawa 1 , Hiroyuki Fujii 1 , Tetsuo Kitano 1 , Hidenori Kobayashi 1 , Shinjiro Yamamoto 1 1Department of Neurosurgery, School of Medicine, University of Kanazawa pp.143-149
Published Date 1976/2/1
DOI https://doi.org/10.11477/mf.1406203839
  • Abstract
  • Look Inside

It is accepted that cerebrovascular dilatation isa constant response during the advanced stage ofintracranial hypertension. Severe intracranial hy-pertension ultimately associates with profund vaso-dilatation and reduces cerebral blood flow to zero.This irreversible state is called cerebral vasomotorparalysis by Langfitt et al (1965). The richadrenergic nerve supply of the cerebral vesselssuggests that ptessor amines possibly affect thecerebral circulation and the cerebral vascular tone.This study is to investigate the reactivity ofnorepinephrine and phentolamine on intracranialpressure (ICP) in patients with severe intracranialhypertension.

The ICP and systemic blood pressure (SBP) mo-nitorings were carried out continuously after theevacuation of intracerebral hematomas due to rup-tured intracranial aneurysms. Severe intracranialhypertension due to brain swelling was observedin these patients.

Three stages were defined according to the re-activity to norepinephrine and phentolamine on theICP. In Stage I, norepinephrine caused a transientdecrease in the ICP and phentolamine caused amarked rise in the ICP. Stage II was marked by theabsence of the ICP response to norepinephrineand phentolamine. During Stage III, the ICPchanged synchronously with a variation of the SBPafter the administration of norepinephrine andphentolamine.

In Stage I patients, the mean ICP level wasbetween 500-1000 mmH2O. Tracing of the ICP inthis group showed transient rises called pressurewaves and the waves were recurring increases inthe ICP to value of 300-500 mmH2O superimposedon an elevated level of the ICP. On the otherhand, in Stage II and III patients, the ICP levelexceeded 1000 mmH2O. Tracing of the ICP inthese groups showed only variations by the arterialpulses.

The patients in Stage I had a well prognosis forlife if proper treatments such as continuous ven-tricular drainage were carried out. The patientsin Stage II and III had a poor prognosis for lifeinspite of continuous ventricular drainage.

There are varying stages in cerebrovascular dil-atation accompanying intracranial hypertension.We have no information on the mechanism of thiscerebrovascular dilatation at present. However, wespeculate that the pressor amines such as norepine-phrine may partly participate in the mechanismresponsible for the vasodilation. So, we attemptto grade the degree of this vasodilatation accordingto the reactivity of norepinephrine and phentolamineon the ICP. It is presumed that cerebrovasculardilatation is slight and reversible in Stage I patients,whereas cerebrovascular dilatation is profund andirreversible in Stage II and III patients.

Continuous ICP recording and examination of thereactivity to norepinephrine and phentolamine onthe ICP are valuable when considering the prognosisfor life in patients with severe intracranial hyper-tension.


Copyright © 1976, Igaku-Shoin Ltd. All rights reserved.

基本情報

電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

関連文献

もっと見る

文献を共有