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I.はじめに
くも膜下出血の急性期には,心電図の変化や収縮期高血圧等がみられ交感神経系の機能に異常をきたしていることが示唆されている17,19)。Neil-Dwyerら13)は,くも膜下出血の患者の尿中カテコラミンとその代謝産物が増加していることを報告している。このことは,くも膜下出血で交感神経系の機能が亢進していることを直接的に示しているものと考えられる。われわれも,交感神経機能の生化学的な指標となるとされている18,20)血漿ドーパミン—β—水酸化酵素(Dopamine—β—hydroxylase,以下DBHと略す)をくも膜下出血の患者で経日的に測定し,発症後一時的に交感神経機能が亢進することをすでに報告した1)。
本論文では,くも膜下出血の急性期における血漿DBH活性の経日変動と,脳血管攣縮や手術あるいは鎮静鎮痛剤使用との関係について,発症48時間以内に入院した患者で検討したので報告する。
In 24 patients with subarachnoid hemorrhage (SAH) who were admitted within 48 hours after the onset, the activity of dopamine-β-hydroxylase (DBH) in peripheral venous plasma was analyzed applying the method described by Nagatsu and Udenfriend (Clin. Chem., 18:980-983, 1972) with a minor modification. Plasma samples were serially collected every a few days for three days to four weeks after the onset.
DBH activity in peripheral venous plasma in-creased markedly after the onset, reaching the highest level within 48 hours, and thereafter de-clined time-dependently for about two weeks. There was no significant difference in the plasma DBH activities on admission between patients with and without cerebrovascular spasm revealed by angiography. The decline of the activity was significantly remarkable in patients with spasm compared with those without spasm. The difference was most prominent around the 7th day after the onset when spasm was shown most frequently.
Neurosurgery or administration of analgesics and/or sedatives had little effect on the changes in plasma DBH activity in acute SAH. The activity correlated with the pressure of cerebrospinal fluid (r=0.587, P<0.05), when it was higher than the normal range.
With these results we obtained following: 1) The activity of sympathetic nervous system in-creases following SAH for a week after the onset. 2) The activity declines more rapidly in patients with cerebrovascular spasm than those without spasm, when it was judged from the activity of plasma DBH activity.
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