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。

Brain and Nerve No to Shinkei Volume 32, Issue 6 （June 1980）

Brain and Nerve 脳と神経 32巻6号（1980年6月発行）

Japanese English

原著

脳神経外科術後の副腎皮質ステロイド投与法の差異によるACTH副腎皮質系機能の回復過程の相違について PITUITARY ADRENOCORTICAL RESPONSE TO HIGH DOSE ADMINISTRATION OF BETAMETHASONE IN NEUROSURGICAL PATIENTS 大久保正 ¹ , 久保長生 ¹ , 神保実 ¹ , 喜多村孝一 ¹ , 出村博 ² , 出村黎子 ² , 鎮目和夫 ² Tadashi Ohkubo ¹ , Osami Kubo ¹ , Minoru Jimbo ¹ , Koichi Kitamura ¹ , Hiroshi Demura ² , Reiko Demura ² , Kazuo Shizume ² ¹東京女子医大脳神経センター脳神経外科 ²東京女子医大内科 ¹Department of Neurosurgery, Neurological Institute,Tokyo Women's Medical College ²Department of Internal Medicine, Tokyo Women's Medical College pp.593-599

発行日 1980年6月1日 Published Date 1980/6/1

DOI https://doi.org/10.11477/mf.1406204597

PDF(4709KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

1．はじめに

　脳浮腫は，脳腫瘍，脳血管障害，頭部外傷頭蓋内炎症性疾患などの種々の病態に際してみられ，これに対する対策のいかんはその原疾患の予後を大きく左右する。この脳浮腫に対しマニトール，グリセロールなどの脱水剤とともに広く副腎皮質ステロイド剤が使用されている。

　副腎皮質ステロイドが脳神経外科臨床に導入された初期の報告には，1954年Russek^15）の脳塞栓，脳血栓に対するCortisoneの効果，1957年に乳癌の脳転移にPre—donisoloneが著効を示すとのKofmanらの報告^8），1961年にGalicich^2）の脳腫瘍に伴つた脳浮腕に対するデキサメサゾンの有効例の報告，そして1962年Rasmussen^16）の術後脳浮腫に対するステロイドの臨床効果の報告などがある。さらにわが国においては，翌1963年，佐野，畠中^17）によりステロイドの有効性が実験的に証明されて以来，種々の副腎皮質ステロイドが広く使用されるようになつた。

Using RIA technique, response patterns of ACTH-adrenocortical system to short term large dose corticosteroid therapy for neurosurgical patients were investigated.

The subjects were consisted of 20 males and 13 females, ageing ranging from 10 to 60 years old. The subjects were devided into three groups ac-cording to mode of steroid administration.

In the first group, 12 mg/day of betamethasone were administered for 5 days and cancelled without gradual reduction.

In the second group, 12 mg/day of betamethasone were administered for 4 days and 6 mg/day of betamethasone were given for following 2 days.

In the third group, 12 mg/day of betamethasone were administered for 3 days and gradual reductioncf betamethasone was given for following 4-5 days.

Response of plasma cortisol level to synthetic 18-ACTH were measured in all patients for 3 days after betamethasone administration cancelled.

The results led to the following conclusion.

1) The second and third groups had not any clinical symptom after steroid cancelled, but one half cases of the first group had mild headache, nausea for 2 days after cancelled.

2) Recovery process of adrenocortical function in the second group is most rapidly, compared with that in other two groups.

3) In the postoperative steroid therapy in neuro-surgery, it could be concluded that 4 days massive administration of steroid followed by stepwise reduction in 2 days would be functionally well tolerated by adrenocortical system.