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 45, Issue 5 （May 1993）

Brain and Nerve 脳と神経 45巻5号（1993年5月発行）

Japanese English

原著

くも膜下出血後の脳血管攣縮と血漿心房性Na利尿ペプチド・抗利尿ホルモン A Study of Plasma Atrial Natriuretic Peptide, Antidiuretic Hormone and Cerebral Vasospasms in Patients with Aneurysmal Subarachnoid Hemorrhage 森永一生 ¹ , 林征志 ¹ , 松本行弘 ¹ , 大宮信行 ¹ , 三上淳一 ¹ , 上田幹也 ¹ , 佐藤宏之 ¹ , 井上慶俊 ¹ , 大川原修二 ¹ Kazuo Morinaga ¹ , Seiji Hayashi ¹ , Yukihiro Matsumoto ¹ , Nobuyuki Omiya ¹ , Junichi Mikami ¹ , Mikiya Ueda ¹ , Hiroyuki Sato ¹ , Yoshitoshi Inoue ¹ , Shuji Okawara ¹ ¹大川原脳神経外科病院 ¹Okawara Neurosurgical Hospital キーワード： subarachnoid hemorrhage , cerebral vasospasm , atrial natriuretic peptide（ANP） , antidiuretic hormone（ADH） Keyword: subarachnoid hemorrhage , cerebral vasospasm , atrial natriuretic peptide（ANP） , antidiuretic hormone（ADH） pp.445-448

発行日 1993年5月1日 Published Date 1993/5/1

DOI https://doi.org/10.11477/mf.1406900480

PDF(2763KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

　くも膜下出血後に高値を呈する血漿ANP，ADHと低Na血症，および脳血管攣縮の関係を検討した。過去3年間にくも膜下出血で入院し，血漿ANP，ADHを経時的に測定し得た23例を対象とした。脳血管攣縮は，脳血管写所見（a-VS），臨床症状（s-VS），CT上のLDAの有無で評価した。低Na血症は130mEq／l以下が2日間以上持続する症例とした。

　その結果a-VSは17例（85％），s-VSは15例（65.2％），CT上のLDAは9例（40.9％），低Na血症は8例（34.8％）に認められ，低Na血症が発生した8例中7例でs-VSを認め，高率であった。また，s-VS発生例の血漿ANP，ADHは各々76.7±32.1pg／ml，2.2±0.7pg／ml，非発生例は各々38.3±21.3pg／ml，2.4±0.6 pg／mlで，血漿ANP値はs-VS発生例で有意に高値であった。

　以上の結果から，ANPの不適切分泌が低張性脱水を招来し，脳血管攣縮の増悪因子になり得ると考えられる。

The relationship between plasma atrial natriure-tic peptide (ANP) and antidiuretic hormone (AD H) both of which show high values after subarach-noid hemorrhage and cerebral vasospasm was stu-died.

The subjects were 23 patients who were admitted because of aneurysmal subarachnoid hemorrhage during three years from March, 1989 to March, 1992 and in whom plasma ANP and ADH levels could be determined over time. Cerebral vasospasm was evaluated by the finding of cerebral angiography, clinical symptoms, and presence or not of low den-sity areas on CT. Hyponatremia was defined as the serum sodium level of 130 mEq/l or less for two days or more.

Angiographical vasospasm was found in 17 pati-ents (85%), symptomatic vasospasm in 15 patients ( 65.2%), low density areas on CT in 9 patients (40.9%) and hyponatremia in 8 patients (34.8%). Symptomatic vasospasm was noted in 7 of the 8 pa-tients (87.5%) with hyponatremia, low density areas on CT in 4 patients (50%), the detection rate being high.

The plasma ANP and ADH levels were 76.7±32.1 pg/ml and 2.2±0.7 pg/ml respectively in the patients with symptomatic vasospasm against 38.3±21.3 pg/ ml and 2.4±0.6 pg/ ml respectively without symptomatic vasospasm, the plasma ANP level being significantly high in the patients with sym-ptomatic vasospasm (p＜0.01).

The plasma ANP and ADH were 71.2±33.8 pg/ ml and 2.0±1.1 pg/ml respectively in the patients with low density areas on CT against 51.2±31.3 pg/ ml and 1.8±0.5 pg/ml respectively without low density areas on CT. The plasma ANP level tended to be high in the patients with low density areas, but no significant difference was found.

The plasma ANP level is significantly high in the patients with symptomatic vasospasm. Inadequate secretion of ANP causes hypotonic dehydration, which could be a factor to aggravate cerebral vasospasm.