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Brain and Nerve No to Shinkei Volume 35, Issue 12 （December 1983）

Brain and Nerve 脳と神経 35巻12号（1983年12月発行）

Japanese English

原著

脳圧降下剤mannitolおよびglycerolの反跳現象に関する研究 A CLINICAL STUDY OF MANNITOL AND GLYCEROL ON THEIR REBOUND PHENOMENON 野手洋治 ¹ , 矢嶋浩三 ¹ , 中沢省三 ¹ Yoji Node ¹ , Kouzo Yajima ¹ , Shozo Nakazawa ¹ ¹日本医科大学脳神経外科 ¹Department of Neurosurgery, Nippon Medical School pp.1241-1246

発行日 1983年12月1日 Published Date 1983/12/1

DOI https://doi.org/10.11477/mf.1406205239

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Abstract 文献概要
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　抄録　Mannitolおよびglycerolは脳圧降下を目的として臨床的に幅広く用いられているが，それらを使用する過程でいわゆる反跳現象が出現することは稀ならず経験することである。今回著者らは頭蓋内圧亢進を有する65症例に対してmannitolまたはglycerolをそれぞれ投与方法を異にして総計266回投与し硬膜上頭蓋内圧を連続測定することにより，反跳現象の出現頻度，頭蓋内圧の，上昇率，持続時間などについて具体的に検討した。まずmannitol群では12.1％に，glycerol群では33.6％に反跳現象が出現し，統計学上でも有意（p＜0.01）にmannitol群の方が出現頻度が低かった。またglycerol群では投与方法によりその出現頻度に著しい差異がみられた。反跳現象山現の際の頭蓋内圧の上昇率はmannitol群では約22％，glycerol群では約32％であった。持続時間はmannitol群では約77分，glycerol群では約116分であった。mannitol群においては投与方法により反跳現象の出現様式に差異はなく，かつその出現頻度も低いことがわかった。一方glycerol群では投与方法により出現様式が一定ではなく，かつmannitol群と比べ出現頻度が高かったが，投与量と投与時間を考慮することにより反跳現象の出現を従来より低率に抑えられることがわかった。即ち反跳現象を低率に抑えるglycerolの至適投与方法は0.5g／kg30分間投与または1.0g／kg 120分間投与の方法が最良であると結論された。

A rebound phenomenon after infusion of hyper-tonic solution of mannitol and glycerol on raised intracranial pressure was studied by epidural pres-sure recordings for 65 patients. The mean age of the patients was 50 years with a range of 29 to 73 years. The diagnoses of above patients were as follows ; 29 were cerebral aneurysms, 19 were brain tumors, 10 were hypertensive intracerebral hemorrhages, 4 were cerebral contusions, 2 were arteriovenous malformations, and one was cerebral abscess. Four methods of infusion were performed. In group A, 0.5 g/kg of mannitol was infused with-in 15, 30 or 60 minutes. In group B, 1.0 g/kg of mannitol was infused within 30, 60 or 90 minutes.In group C, 0.5 g/kg of glycerol in 5% fructose was infused within 30, 60 or 90 minutes. In group D, 1.0 g/kg of glycerol in 5% fructose was infused within 60, 120 or 180 minutes. The following ob-servations were examined in all patients. (1) The occurrence of the rebound phenomenon. (2) The rate of the raised intracranial pressure (ICP) com-pared to the ICP before infusion of these hyper-tonic solutions. (3) The duration of the rebound phenomenon.

Results : A rebound phenomenon was found 23 % in all patients, and 12% in the mannitol groups and 34% in the glycerol groups. The dose and the rate of mannitol infusion did not influence the occurrence of the rebound phenomenon.

In contrast,in the glycerol groups, the infusion method did influence the occurrence of the rebound phenomenon. However, the rebound phenomenon was found in less than 18% when glycerol was infused within 30 minutes in group C and within 120 minutes in group D. When the rebound phe-nomenon was occurred, ICP was increased about 22% in manitol groups, and about 32% in glycerol groups. The duration of the rebound phenomenon was about 64 minutes in group A, 90 minutes in group B, 106 minutes in group C, and 122 minutes in group D.

There were many differences between mannitol and glycerol on their rebound phenomenon. We concluded that the optimal dose and rate of gly-cerol infusion was O.5 g/kg infused within 30 mi-nutes and/or 1.0 g/kg within 120 minutes for re-ducing of occurrence of the rebound phenomenon.