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 39, Issue 3 （March 1987）

Brain and Nerve 脳と神経 39巻3号（1987年3月発行）

Japanese English

原著

髄液の流通・吸収障害を主体とする頭蓋内圧亢進と脳循環—高酸素血症，glycerol，脳室ドレナージの与える影響 EFFECTS OF HYPEROXIA, GLYCEROL AND VENTRICULAR DRAINAGE ON ICP AND CBF IN PATIENTS WITH INCREASED ICP DUE TO CSF CIRCULATORY-ABSORBANCE DISTURBANCE 大田英則 ^1,2 , 鈴木英一 ¹ , 日沼吉孝 ¹ , 川村伸悟 ² , 根本正史 ² , 波出石弘 ² Hidenori Ohta ^1,2 , Eiichi Suzuki ¹ , Yoshitaka Hinuma ¹ , Shingo Kawamura ² , Masahito Nemoto ² , Hiromu Hadeishi ² ¹秋田県立脳血管研究センター高気圧酸素治療室 ²秋田県立脳血管研究センター脳神経外科 ¹Division of Hyperbaric Medicine for Brain and Blood Vessels-AKITA ²Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-AKITA pp.273-279

発行日 1987年3月1日 Published Date 1987/3/1

DOI https://doi.org/10.11477/mf.1406205878

PDF(5080KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

　抄録　髄液の流通・吸収障害を主体とする頭蓋内圧（ICP）亢進に対して①高気圧酸素（HBO）をも含めた高酸素血症，②glycerol，③脳室ドレナージ，の効果をICPと脳循環（CBF）の同時測定により検討した。ICPは脳室圧（VFP）を測定し，CBFは10mCi¹³³Xe静注法によりISIを算出した。対象はクモ膜下出血術後19例と脳室穿破を伴う脳出血2例の計21例であった。高酸素血症下でICPおよびCBFは有意な減少を認めたが，ICPが高いほどCBFの減少率が低い傾向が見られ，ICP亢進の程度に応じて脳血管の酸素反応性障害がおこっていることを示唆していた。また高酸素血症によるCBF,ICPの減少は一時的なものであった。200ml Glyceol®投与ではCBFは増加し，ICPは減少した。脳室ドレナージによるICP下降措置によりCBFは増加し，ICPが高いほどドレナージ後のCBF上昇は著しかった。髄液の流通・吸収障害によるICP亢進はCBFを減少させ脳障害をさらに進行させると考えられる。これに対してICPをモニターしつつcontrolled ventricular drainage （CVD），　glycerol投与やHBO療法を組合わせて対処することは有意義であると考えられた。

The effects of hyperoxia, glycerol and ventricu-lar drainage on intracranial pressure (ICP) and cerebral blood flow (CBF) were studied in cases with cerebrospinal fluid (CSF) circulatory-absorb-ance disturbance due to subarachnoid hemorrhage (SAH) or intraventricular hematoma. Ventricular fluid pressure (VFP) was monitored through a controlled ventricular drainage (CVD) tube using a Statham P-50 pressure transducer. CBF was measured by the 10mCi¹³³Xe intravenous injection method using a Valmet BI-1400 rCBF analyzer. ISI (initial slope index) was used for the CBF value. Studied cases were 19 SAH patients and 2 hypertensive intracerebral hematoma cases with intraventricular hematoma.

Hyperoxia included hyperbaric oxygen (HBO), reduced ICP and CBF. During pure oxygen in-halation at atmospheric pressure (1ATA･O₂), there was a tendency toward a relationship showing that the higher the resting state ICP, the lesser the likelyhood of a CBF decrease. This may indicate that increased ICP impairs cerebral vas-cular reactivity to hyperoxia in relation to the degree of elevation. The effects of hyperoxia on ICP and CBF were temporary and they promptly returned to the resting state after cessation of oxygen inhalation. In some cases, there was a rebound phenomenon in ICP after HBO.

Glycerol administration reduced ICP and increa-sed CBF. There was no clear correlation between resting state ICP and CBF increase after glycerol administration. The effects of glycerol were also temporary.

ICP control by opening CVD increased CBF. There was a correlation between the level of resting state ICP and the CBF increase after the opening of CVD.

In cases with CSF circulatory-absorbance disturb-ance, elevated ICP reduced CBF and may further worsen the cerebral damage. In such cases, ICP control by CVD is a very important therapeutic procedure for increasing CBF and improving pa-tient condition. Glycerol administration and HBO also may be useful but should be used in conjunc-tion with CVD because of the temporary effect, especially in cases with increased ICP.