脳室内髄液搏動波の継時的観察—波型分析の立場で

CONTINUOUS OBSERVATION & ANALYSIS OF VENTRICULAR PULSE WAVE

I．はじめに

　髄液動態の研究の一環として，脳脊髄液（cerebrospinalfluid：CSF）の搏動を波型としてとらえ分析することによつて，その生理的意義，各種病態との関係を明らかにすることは興味のあるところである。現在まで，多くの研究は頭蓋内圧（intracranial pressure：ICP）との関係についてであり，とくにICPを安全かつ継時的に測定しようとする工夫と研究とがある^1,8〜10）。

　一方，CSFの搏動を波型として捕捉し，近年発達したpressure transducerによつて得られた波型にほぼ近似の波として研究に供されたのは1950年代に入つてからで，この意味ではGerlach^5），Bering^2）等が，その緒を胴いたといつて過言ではない。しかしながらCSFの波型の基本的な構成波の同定，更にはその基源についても動脈波あるいは静脈波との関係がいわれ，すべてが解明されたわけではない。

As one of the research to clarify the dynamics of cerebrospinal fluid (CSF), and the significance of pulsation, the ventricular pulse wave (VPW) was continuously recorded and analyzed. The wave was like a sawtooth wave which composed of small peaks, and constantly obtained by the direct method that Statham P₃₇ pressure transducer was con-nected with ventricular catheter in cases needed ventricular drainage in acute stage due to subara-chnoid hemorrhage.

The results could be obtained as follows.

1) The fundamental component wave of VPW was ascertained and named. A VPW composed of 4 or 5 small peaks. The starting point of a saw tooth wae was named P₀, the first peak P₁, the second P₂, P₃, P₄ and P₅. P₁, P₂ and P₃ among them constantly and apparantly appeared, but P₄ and P₅ were obscure in some cases. Thus, P₁, P₂ and P₃ were named constant wave, and measured in latency and height from Po.

2) In effective cases of giving the hypertonic

solution, P₁, P₂ and P₃ increased in height gradu-ally. After that, the sawtooth wave with P₂ higher that P₁ in height appeared. Furthermore, the fluctuation caused by respiratory effects in-creased in correspondence with effectiveness of hypertonic solution.

The same findings were seen in effective cases, of which V-P shunting operation which was performed for hydrocephalus after subarachnoid hemorrhage.

3) The corelationship of each component waveof VPW and carotid arterial pulse (Car) were ex-amined by simultaneous recording each others. The each component wave had 16 msec delay to that of Car. And also each P₁, P₂ and P₃ of VPW corresponded with P, T and DW in latency and shape.

4) The pattern of VPW would be devided into three groups : normal ICP pattern, high ICP pattern, low ICP pattern. The pattern of VPW changed simultaneously with Car, and pathogenesis of background as well as ICP.