開頭術前後におけるmethylprednisolone投与量と副作用，臨床効果の検討—術後脳浮腫と血清β—glucuronidase値の変動について

A STUDY OF OPTIMUM DOSE OF A GLUCOCORTICOID, METHYLIPREDNISOLONE SODIUM SUCCINATE, BEFORE AND AFTER NEUROSURGICAL MAJOR OPERATIONS:RELATIONSHIP BETWEEN SERUM β-GLUCURONIDASE LEVEL AND POST OPERATIVE BRAIN EDEMA

　抄録　脳神経外科領域の開頭術前後にmethylprednisoloneを一定期間漸減投与し，最大投与量を変えることにより副作用の出現状況と臨床効果を検討した。最大投与量5mg／kg／day,10mg／kg／day群では副作用が軽微であった。最大投与量15mg／kg／day群では感染症の合併例が多かった。5mg／kg／day群は10mg／kg／day群，15mg／kg／day群と比較して臨床効果が明確ではなかった。また開頭術前後にlysosornal enzymeの一つであるβ—glucuronidaseの血清レベルを測定し，術後脳浮腫の認められた全例で，術後2日目から7日目にかけて上昇し以後回復する傾向を示した。これは脳浮腫の時期に同調し，その客観的評価のparameterとなりうる可能性が示唆された。またmethylprednisolone 10mg／kg／day投与群に比し，術後一旦上昇したβ—glucuronidase　値の回復がやや早い傾向を示し，methylprednisoloneの薬剤効果かとも考えられた。

The effects of pre-and postoperative administra-tion of methylprednisolone (5, 10, 15mg/kg/day) was studied on 50 cases of major neurosurgical operation. The serum level of β-glucuronidase was also analyzed in 20 cases so as to determine whether it could be useful as an indicator of post operative brain edema.

Methylprednisolone seemed to be effective in the cases administrated in the dosage of 10, 15mg/ kg/day. However, several kinds of postoperative infections were seen in the cases administrated 15mg/kg/day. The results may suggest that the dosage tested, 10 mg/kg/day, causes little side effects while it is clinically effective.

The serum level of β-glucuronidase tended to increase from the second postoperative day to the seventh day. Those increase were remarkably in the cases with brain edema. Recovery of β-glucuronidase level was earlier in the cases with 10mg/kg/day administrated rather than in the cases with 5mg/kg/day administrated. These results suggest that the measurement of serum β-glucuronidase level may be useful for evaluating the degree of brain edema.