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Brain and Nerve No to Shinkei Volume 43, Issue 6 （June 1991）

Brain and Nerve 脳と神経 43巻6号（1991年6月発行）

Japanese English

原著

体外循環法による全身温熱療法の正常脳に及ぼす影響 Influence of Total Body Hyperthermia on Normal Brain Tissue 勝村浩敏 ¹ , 兜正則 ¹ , 細谷和生 ¹ , 河野寛一 ¹ , 古林秀則 ¹ , 半田裕二 ¹ , 林實 ¹ Hirotoshi Katsumura ¹ , Masanori Kabuto ¹ , Kazuo Hosotani ¹ , Hirokazu Kawano ¹ , Hidenori Kobayashi ¹ , Yuji Handa ¹ , Minoru Hayashi ¹ ¹福井医科大学脳神経外科 ¹Department of Neurosurgery, Fukui Medical School キーワード： total body hyperthermia , cerebral blood flow , intracranial pressure , cerebral autoregulation Keyword: total body hyperthermia , cerebral blood flow , intracranial pressure , cerebral autoregulation pp.569-575

発行日 1991年6月1日 Published Date 1991/6/1

DOI https://doi.org/10.11477/mf.1406900210

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Abstract 文献概要
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　悪性腫瘍に対する温熱療法として外科領域で行われている体外循環法を用いて全身加温を行った場合の正常脳に及ぼす影響を成犬を用いて検討した。体外循環法を用いて，直腸温41.5〜42.0℃2時間（HT期）の全身加温を行い，脳温，脳血流量，頭蓋内圧，脳組織pH，脳波，脳組織および脳血流自動調節能を検討した。HT期に脳温は，脳表より0.5cm内側では直腸温より0.6±0.2℃低温を示した。脳血流量は11.0±7.2ml／100g／min，頭蓋内圧は最大6.5±3.4mmHg上昇したが，復温によりそれぞれ前値に回復した。脳組織pHは加温前値が7.33±0.02であったのに対し7.17±0.09と低下し，脳波は徐波化と低振幅化を示したが復温によりいずれも正常化した。組織学的検討では加温による明らかな変化を認めなかった。また全身血圧の変動に対して脳血流量，頭蓋内圧はパラレルに変動し脳血流自動調節の低下が認められたが，復温により正常化した。以上の結果より，41.5〜42.0℃2時間程度の全身加温は，今回の検索における限り臨床上問題はないと考えられたが，加温中にみられた脳血流自動調節能の低下は，血圧，頭蓋内圧の十分な管理の必要性を示唆した。

The influence of total body hyperthermia (TBHT) on normal brain tissue was studied in 40 dogs. The dogs were anesthetized with sodium thiopental (10mg/kg/hr) intravenously, and were ventilated by artificial respirator. The TBHT was induced by extracorporeal circuit in corporating a heat exchanger. Rectal temperature was raised to 41.5℃ and maintained at 41.5 -42.0℃ for 2 hr (HT period) and was then fallen to normothermia by cooling, Regional cerebral blood flow (CBF) was measured by hydrogen clearance method before heating, during and after TBHT treatment. Brain temperature, rectal temperature, intracranial pres-sure (ICP), brain tissue pH and electroencephalo-graphy (EEG) were monitored continuously during TBHT. Histopathological changes of the brain tis-sue were studied in dogs killed just after TBHT and 2 weeks after TBHT. Autoregulation of the CBFduring HT period was assessed by measuring the regional CBF and the ICP at a state of induced hypo - or hypertension.

The brain temperature (at the depth of 5mm under the brain surface) was usually 0.6℃ lower than the rectal temperature during HT period. The regional CBF increased from 38.1±6.5 (mean ± SD) to 49.1±9.8ml/100 g/min by raising rectal temperature, and it recovered to a normal value after cooling. The ICP increased from 10.3±4.2 to 16.8±3.4 mmHg by raising rectal temperature, and it returned to a normal value after cooling. Brain tissue pH decreased from 7. 33±0. 02 to 7.17±0.09 rapidly when the rectal temperature reached 41.0℃, and then returned to a normal value gradually after the start of cooling. The EEG showed 18Hz fast waves and alpha waves before TBHT, but slowwaves predominated and the frequencies markedly reduced as the rectal temperature was raised. No histopathological changes were observed on the brain tissue which was removed just after the TBHT and 2 weeks after the TBHT. The regional CBF and the ICP changed in parallel with induced changes of mean arterial blood pressure during HT period. These changes confirmed that the autor-egulation of the CBF was impaired during HT period. Changes of the CBF, ICP, EEG and impair-ment of the autoregulation of the CBF during TBHT were reversible. We suggest that care must be taken of systemic arterial blood pressure during TBHT, because the impairment of the autoregula-tion may induce cerebral ischemia and cerebral edema easily if blood pressure change markedly.