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 35, Issue 5 （May 1983）

Brain and Nerve 脳と神経 35巻5号（1983年5月発行）

Japanese English

原著

高血圧性基底核部出血に対するグリセロールの脳血流改善作用 IMPROVEMENT OF CBF BY GLYCEROL ADMINISTRATION IN HYPERTENSIVE INTRACEREBRAL HEMORRHAGE 佐々木雄彦 ¹ , 松崎隆幸 ¹ , 中川原譲二 ¹ , 佐藤茂 ¹ , 川合裕 ¹ , 末松克美 ² Takehiko Sasaki ¹ , Takayuki Matsuzaki ¹ , Jyoji Nakagawara ¹ , Shigeru Satoh ¹ , Yutaka Kawai ¹ , Katsumi Suematsu ² ¹中村記念病院脳神経外科 ²中村記念病院脳血管研究所 ¹Department of Neurosurgical Clinic, Nakamura Memorial Hospital ²Stroke Research Laboratory, Nakamura Memorial Hospital pp.505-510

発行日 1983年5月1日 Published Date 1983/5/1

DOI https://doi.org/10.11477/mf.1406205126

PDF(4311KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

　抄録　脳出血の脳循環動態の研究の進歩により，脳出血急性期において脳血流量（CBF）の低下が認められ，グリセロールの投与によりCBFの改善が得られることが知られてきた。しかし，本症に対するグリセロールの脳血流改善作用の機序はいまだ明確ではない。本報告では，高血圧性基底核部出血例について検討を加え，グリセロールの脳血流改善作用について考察した。急性期高血圧性基底核部出血14例について，グリセロール投与前後のCBFを，1）¹³³Xe内頸動脈内注入法により，initial slope法で計測する方法，2）内頸動静脈血酸素濃度較差の逆数をCBF indexとする方法，の2つの方法で比較検討した。また，グリセロール投与によるhemodilutionとCBF改善の関係を知るために，血漿浸透圧とヘマトクリットの変化も検討した。グリセロールの投与によりCBFは改善し，血漿浸透圧は上昇しヘマトクリットは下降した。またCBFの変化は，ヘマトクリットの低下に良く同調した態度をとることが明らかとなった。以上より，グリセロール投与により，組織内から血管内への水の移動にもとづくhemodilutionが生じ，脳微小循環が改善されることが脳血流改善の重要な機序であると考えられた。

To confirm the positive effect of glycerol adminis-tration on the improvement of CBF, 14 cases of hypertensive intracerebral hematoma, including 7 putaminal hemorrhages and 7 thalamic hemorrha-ges, were studied.

Two different methods were adopted to compair the CBF before and after glycerol administration, one was ¹³³Xe intra-arterial injection (initial slope method) and the other was CBF index which was estimated from difference of O₂ content between arterial and internal jugular venous blood. To confirm the hemodilution effect of glycerol as a hypertonic agent, changes of serum osmotic pres-sure and hematocrit, before and after glycerol administration, were observed.

CBF increased 5% by means of hemispheric value measured by ¹³³Xe intra-arterial injection method, and14.2% by CBF index. The difference of CBF improvement rate between these two methods comes from the fact that CBF indexinvolves the blood flow at the deep structure of the cerebrum and even at the contralateral hemi-sphere affected by distortion of brain with acute growingmass. The increase of serum osmotic pressure was observed, while hematocrit was re-duced after glycerol administration. It means that administration of hypertonic glycerol has caused hemodilution.

In a case whom ICP was monitored continuously through the ventricular catheter, ICP was reduced by glycerol administration. However, improvement of CBF is more related to hematocrit reduction than to ICP reduction. In this case reduction of ICP produced by CSF removal from ventricular catheter did not show CBF improvement at all.

These results led us to the conclusion that the mechanism of CBF improvement by glycerol administration is not only the increase of the cerebral perfusion pressure by reduction of ICP, but also the functional improvement of the cereb-ral microcirculation by hemodilution produced by glycerol administration as a hypertonic agent. We emphasized the hemodilution effect of glycerol on microcirculation which was disturbed by comp-ression of acute growing hematoma and subseq-uentperi-focal edema.