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Brain and Nerve No to Shinkei Volume 39, Issue 7 （July 1987）

Brain and Nerve 脳と神経 39巻7号（1987年7月発行）

Japanese English

原著

腰部クモ膜下腔圧測定法の有用性についての検討 CLINICAL VALIDITY OF LUMBAR SUBARACHNOID PRESSURE MEASUREMENT 絹田祐司 ¹ , 石川正恒 ¹ , 平井収 ^1,2 , 吉田真三 ¹ , 今高清晴 ¹ , 小林修一 ¹ , 半田肇 ^1,2 Yuji Kinuta ¹ , Masatsune Ishikawa ¹ , Osamu Hirai ^1,2 , Shinzou Yoshida ¹ , Kiyoharu Imataka ¹ , Shuichi Kobayashi ¹ , Hajime Handa ^1,2 ¹京都大学医学部脳神経外科 ²現籍：浜松労災病院 ¹Department of Neurosurgery, Kyoto University pp.673-678

発行日 1987年7月1日 Published Date 1987/7/1

DOI https://doi.org/10.11477/mf.1406205939

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Abstract 文献概要
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　抄録　頭蓋内圧（ICP）測定法の一つに腰部クモ膜下腔圧（LSP）の測定があり，われわれは正常圧水頭症などの占拠性病変がなく脳ヘルニアの危険の少ない症例に適用している。本法は簡便で患者への侵襲が少ない利点があるが，ICPをどの程度反映するかが問題である。そこで成猫を用い大槽より生理食塩水を注入しLSPとICP （epidural pressure；EDP）の関係を調べた。steady state infusionではLSPとEDPの相関は良好でLSPはEDPの少なくとも80％以上の値を示した。bolus injectionでもLSPとEDPの圧変化は高い相関を示し，LSPは急激な圧変化も十分追従し得た。しかしcomplianceについては低圧時にLSPのものがEDPのものより大きく計測される傾向があった。脈圧については圧の上昇に従い，LSPとEDPの脈圧も同様に大きくなるが，LSPの脈圧はほぼ一定の差をもってEDPの脈圧より小さかった。以上より，低圧時のcomplianceや脈圧の問題もあるが，LSP測定法は少なくとも平均圧や圧波に関してはICPを十分反映すると考えられた。

To evaluate the clinical usefulness for mea-suring lumbar subarachnoid pressure (LSP) as an index of intracranial pressure, the relation be-tween LSP and epidural pressure (EDP) was studied by the cisternal saline infusion and bolus injection in 12 cats at tha range of pressure up to 50 mmHg. In the steady state infusion (0.238 ml/min, 0.476 ml/min), the data from LSP and EDP were correlated very well and the LSP value was at least above 80-90% of EDP value at any pressure level.

In the bolus injection (0.4 ml), the degree of pressure rise and the time course of both LSP and EDP were quite similar at any pressure level. However, the compliance calculated from the pressure change of LSP and EDP revealed to have a different tendency according to the base-line pressure level at bolus injection. Below 10 mmHg of EDP, the compliance calculated from LSP was usually higher that of EDP. This was considered due to the distensibility of spinal theca. But above 10 mmHg of EDP, the compli-ance of both LSP and EDP became almost equal and then gradually decreased as the eleva-tion of baseline pressure at bolus injection. This was considered to be the result of disapperance of the distensible effect of spinal theca.

In this study, two polyetylene tubes of different size (I. D. 0.45 mm, 0.58 mm) were used for spinal drainage tube to compare the pressure dumping effect of tube. However, on both tubes, the pulse pressure of LSP was usually smaller than that of EDP, with each having almost constant difference.

Although the dumping effect of pulse pres-sure was noted, the mean pressure of LSP was the same as that of EDP. Thus, LSP monitor-ing method is useful to study the intracranial pressure-volume relationship with less-invasive-ness.