両側内頸静脈catheterizationによるアルゴン法における脳血流量（CBF）左右差の検討

STUDY FOR LATERALIZATION OF HEMISPHERIC CEREBRAL BLOOD FLOW BY ARGON METHOD WITH CATHETERIZATION INTO BILATERAL INTERNAL JUGULAR BULBS

　抄録　一側大脳半球に限局した虚血巣を有し，横静脈洞から内頸静脈にかけての異常を認めない脳血管障害慢性期の症例24例に，アルゴン脱飽和法による全脳循環測定を施行した。年齢は10〜72歳（平均49歳）。男性17例，女性7例で，右大脳半球に病変を有するもの9例，左側15例である。両側内頸静脈球部と動脈内にカテーテルを留置し，医用質量分析器を使用し，Fickの原理にてCBF値を算出した。この値が左右で20％以上の差を示すものは12例（50％），右側で低下するもの4例（33.3％），左側で低下するもの8例（66.7％）であった。CBF値の有意の左右差を有する12例中，病巣を反映すると考えられたものは9例（75％）に認めた。虚血巣を有する，半球側でのCBFがより疾患を反映することが多いと考えられ，また諸家の報告によれば，静脈洞の左右差は少ない。血流の交会付近での層流の可能性をも考えあわせると，CBF測定においては，虚血側のCBFが，より病態を反映するものと思われた。

Only 24 patients with chronic ischemic cereb-rovascular lesions, which had been lateralized toeither hemisphere of the cerebrum, were analyzed by argon desaturation method measuring bilateral hemispheric blood flows. Their ages varied from 10 to 72 years with a mean of 49 years.

Fifteen patients (62.5%) had localized ischemic lesions in the left cerebral hemispheres and re-maining 9 patients (37.5%) had in the right hemi-spheres. The clinical symptom of each patient was lateralized due to localized ischemic focus. Bilateral transfemoral catheterization of the in-ternal jugular bulbs was successfully performed. Each hemispheric blood flow was calculated by argon desaturation method using mass spectrome-try based on Fick's principle.

Half of the patients, 12 cases revealed lateraliza-tion over 20% significant differences of its values. 8 patients (66. 7%) were reduced significantly in the left hemispheres and 4 patients were contra-laterally. Finally 9 patients revealed that CBF values at the affected side was significantly re-duced with no anatomical differences among sinus systems.

It is probably that CBF value at the affected side reflects its ischemic lesion more than that at the non-affected side.

Several authors reported no predominant lateral-ization between bilateral sinus draining systems. Based on possibility of "laminar flow" in the confluence, CBF value at the affected side is more important. So further investigations are needed for the future.