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Brain and Nerve No to Shinkei Volume 44, Issue 11 （November 1992）

Brain and Nerve 脳と神経 44巻11号（1992年11月発行）

Japanese English

原著

虚血性脳血管障害の局所脳血流量と炭酸ガス反応性—バイパス術前後の検討から Local Cerebral Blood Flow and its CO2 Reactivity in the Ischemic Cerebrovascular Diseases Before and After Bypass 川口正一郎 ¹ , 榊寿右 ¹ , 鎌田喜太郎 ¹ , 岩永秀昭 ¹ Shoichiro Kawaguchi ¹ , Toshisuke Sakaki ¹ , Kitaro Kamada ¹ , Hideaki Iwanaga ¹ ¹奈良県立医科大学脳神経外科 ¹Department of Neurosurgery, Nara Medical University キーワード： CO2 reactivity , ischemic cerebrovascular disease , STA-MCA anastomosis Keyword: CO2 reactivity , ischemic cerebrovascular disease , STA-MCA anastomosis pp.995-1000

発行日 1992年11月1日 Published Date 1992/11/1

DOI https://doi.org/10.11477/mf.1406900403

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Abstract 文献概要
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　STA-MCA吻合術を施行した虚血性脳血管障害21例の局所脳血流動態とそのCO₂反応性について，術中局所脳血流量（LCBF）を吻合術前後に，PaCO₂を平均7.2mmHg低下させ持続的に計測し，LCBFとそのCO₂反応性を観察した。

　吻合前LCBFは対照値に比し有意に低下しており，吻合後有意に増加した。吻合前CO₂反応性は全例対照値以下で著明に低下しており，66.7％の症例では0％／mmHg以下のinverse steal effectを呈した。吻合後CO₂反応性は改善したが，症例によりその変化は多様で，著明に改善する症例も存在した。吻合前CO₂反応性が低下している症例の方が，吻合前局所脳血流量はより少なく，吻合後LCBFの増加量も多くCO₂反応性もより改善した。

　虚血性脳血管障害では，CO₂反応性が障害されており，inverse steal effectの症例も存在した。吻合術により術前CO₂反応性が低い症例ほどLCBF, CO₂反応性ともより改善した。

We evaluated the effects of the STA-MCA anas-tomosis on local cerebral blood flow (LCBF) and CO₂ cerebrovascular reactivity (CVR) in ischemic cerebrovascular diseases (CVD). [Patients and Methods] We examined the LCBF and CVR of 21 patients with ischemic CVD subjected standard STA-MCA anastomosis. During surgery, LCBF was continuously measured using the thermal diffusion method sometimes in a state of decreased PaCO₂ (median : 7.2mmHg) before and after bypass. CVR was represented as %ΔLCBF/ΔCO₂. [Results] 1) In the control group (with non-ruptured aneurysm, n=7), LCBF was 58.6±14.1ml/100g/min and ΔLCBF/ΔCO₂ was 4.68±1.68%/mmHg. 2) Before bypass, LCBF was 46.7±10.3ml/100g/min. It was significantly (p＜0.05) lower than control level. After bypass, LCBF increased significantly (p＜ 0.05) to 62.0±14.3ml/100g/min. 3) Before bypass, %ΔLCBF/ΔCO₂ was -1.36±4.34%/mmHg. In the 14 cases (66.7%), %ΔLCBF/ΔCO₂ was below the 0%/mmHg (inverse steal effect). 4) After bypass, it increased to 0.08±2.73%/mmHg. 11 cases (52.4%) showed %ΔLCBF/ΔCO₂ was above the 0%/mmHg. 5) In the group with a preoperative %ΔLCBF/ΔCO₂ of less than 0%/mmHg, preoperative LCBF was 43.6±9.3ml/100g/min, which was significantly low (p＜0.01) compared to that in the group with higher %ΔLCBF/ΔCO₂. After bypass, LCBF and % ΔLCBF/ΔCO₂ remarkably increased in the group with %ΔLCBF/ΔCO₂ below 0%/mmHg. [Conclu-sion] Before bypass, LCBF was low and CVR was severely disturbed. In the 14 cases %ΔLCBF/ΔCO₂ was below 0%/mmHg. After bypass, LCBF and CVR was improved. The operation exerted a favor-able effect in the low %ΔLCBF/ΔCO₂ group.