DDAVP （1—deamino−8—D-arginine vasopressin）使用による術後尿崩症の管理

EFFECTS OF VASOPRESSIN ANALOGUE DDAVP IN PATIENTS WITH POSTOPERATIVE DIABETES INSIPIDUS

Ⅰ．はじめに

　DDAVP （1—deamino−8—D-arginine vasopressin）はVasopressinの誘導体であり，1966年Zaoralらによつて合成された^17,18）。DDAVPは従来のVasopressin製剤に比し，その生物学的活性において，抗利尿効果が著しく強く，持続時間が長く，また昇圧作用も少ないため，少量で優れた抗利尿効果を示し^3,4,10），点鼻剤として使用できるため患者にあたえる苦痛が少ない^4,6）。この薬剤は1968年以来欧州を中心に臨床応用が普及し^{1,2,4,7,9,10，16）}，1975年よりわが国においても多数の臨床応用例が報告され^{5,6,8,11,13）}，1978年田苗らにより98例の全国集計が報告された^14）。これらの臨床応用例は小児科，内科領域での使用例であるため，慢性期尿崩症に対するDDAVPの使用方法が評価されているが，術後急性期尿崩症にこの薬剤を使用した報告は少ない^2）。

　術後急性期尿崩症は症例により，また手術侵襲の程度に応じてその重症度が異なり，慢性期尿崩症に比し尿量の変動が著しい。このため，DDAVPの使用方法は急性期と慢性期のものとはおのずから趣を異にする。われわれは最近トルコ鞍部およびその近傍腫瘍の術後尿崩症に対するDDAVP投与の適応を検討した。

The effect of DDAVP (1-deamino-8-D-arginine vasopressin), a synthetic analogue of vasopressin,was studied in twelve patients with acute post-operative cranial diabetes insipidus (D.I.).

The most severe D.I. occurred in four cases fol-lowing total removal of tumor (3 pituitary macro-adenoma, 1 dermoid cyst). The urinary volume over 1000ml per hour in these four cases could not be controlled by DDAVP but could be con-trolled by drip infusion of aqueous pitressin (AP) and pitressin tannate in oil (PTO). DDAVP was effective when the urinary volume was decreased in under 500ml per hour.

The mild D.I. occurred in four cases after partial removal of tumor (3 craniopharyngioma, 1 pituitary macroadenoma). These four cases could be con-trolled by drinking water only during one or two postoperative weeks. DDAVP was administered in doses of 10 to 30μg two times daily after 2 or 3 postoperative weeks and the urinary production was normalized.

The four patients developed D.I. after removal of functioning pituitary microadenoma operated by transsphenoidal route. These four cases were treated with drip infusion of AP and PTO during one or two weeks after the operation and were effectively treated with 5 to 15μg of DDAVP in-tranasally every 8 to 12 hours one or two weeks after the operation.

Nine cases in 12 cases with postoperative D.I. became chronic D.I.. The maintenance dose of DDAVP gradually lessened in accordance with de-creasing urinary volume except the two cases of craniopharyngioma. No side effect was experienced for 19 months of treatment.