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Brain and Nerve No to Shinkei Volume 45, Issue 7 （July 1993）

Brain and Nerve 脳と神経 45巻7号（1993年7月発行）

Japanese English

原著

Mannitol投与直後の頭蓋内循環動態の変化—Transcranial DopplerによるPulsatility indexの変化からみた実験的検討 Effect of Rapid Mannitol Infusion on Middle Cerebral Artery Blood Flow Velocity and Pulsatility Index : A Transcranial Doppler Ultrasonography Study in Monkeys 原田克彦 ¹ , 林隆士 ¹ , 姉川繁敬 ¹ , 鳥越隆一郎 ¹ , 西尾暢晃 ² , 森山匠 ³ , 前田健二 ³ , 戸田啓介 ³ Katsuhiko Harada ¹ , Takashi Hayashi ¹ , Shigetaka Anegawa ¹ , Ryuichiroh Torigoe ¹ , Nobuaki Nishio ² , Takumi Moriyama ³ , Kenji Maeda ³ , Keisuke Toda ³ ¹聖マリア病院脳神経センター脳神経外科 ²社会保険田川病院脳神経外科 ³府中恵仁会総合病院脳神経外科 ¹Department of Neurosurgery, Institute of Neurosciences, St Mary's Hospital ²Department of Neurosurgery, Syakaihoken Tagawa Hospital ³Department of Neurosurgery, Fuchu Keijinkai General Hospital キーワード： Mannitol , Transcranial Doppler , pulsatility index , vasoconstriction , autoregulation Keyword: Mannitol , Transcranial Doppler , pulsatility index , vasoconstriction , autoregulation pp.649-654

発行日 1993年7月1日 Published Date 1993/7/1

DOI https://doi.org/10.11477/mf.1406900508

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Abstract 文献概要
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　Mannitol投与直後の血行動態を知る目的で，日本ザルを用いたTranscranial Doppler（TC2-64）による測定から，頭蓋内循環動態の変化をCO₂負荷におけるそれとを比較検討した。Manntiol投与群（n＝8）において，中大脳動脈主幹部血流速度（MCA-FV），内頸動脈血流量（IC-BF）は，Mannitol投与後に有意に増加した（p＜0.005，p＜0.005）。しかし，Pulsatility index（PI）の変化に有意差はみられなかった。CO₂負荷群（n＝15）では，MCA-FV，IC-BFは有意な増加を示した（p＜0.005，p＜0.005）。また，PIも有意な低下を示した（p＜0.005）。このことは頭蓋内圧亢進がなくautoregulationが正常と考えられる状態では，Mannitol投与後のviscosityの低下からCBFの増加をみるが，頭蓋内末梢の脳血管抵抗に変化はないことを示している。そしてPoiseuilleの法則からMannitol投与後早期には末梢血管のvasoconstrictionが存在していると示唆された。それは脳血管がもつautoregulationによるものと考えられた。

Hemodynamic changes immediately after the administration of mannitol were investigated in monkeys (Macaca Fuscata) using transcranial Doppler ultrasound (TC2-64) and were compared with those after CO₂ loading. The CO₂ loading group was hyperventilated to an end-tidal PCO₂ of 36.5±2.21 and hypoventilated to an end-tidal PCO₂ of 46.3 ±2.69. Mean flow velocity in the middle cerebralartery (MCA-FV), Pulsatility index (PI) and blood flow in the internal carotid artery (IC-BF) studies were performed twice before and after hypercap-nea. In the Mannitol group, Mannitol (2 g/kg) was infused at a rate 20 to 30 ml/min. MCA-FV, PI, IC -BF and intracranial pressure (ICP) studies were performed twice before administration and 10 min-utes after administration of Mannitol. In the Man-nitol group (n=8), MCA-FV and IC-BF and ICP increased significantly after administration of Man-nitol (p＜0.005, p＜0.005, p＜0.025) , but there was no significant difference in the PI. In the CO₂ loading group (n=15) , MCA-FV and IC-BF increasedsignificantly (both p＜0.005) and PI decreased significantly (p＜0.005). These results indicated that, in the presence of normal autoregulation without intracranial hypertension, there was no change in the resistance of the peripheral cerebral vessels, while a decrease in viscosity after adminis-tration of Mannitol caused an increase in cerebral blood flow. Hence, acording to Poiseuille's law, peripheral vasoconstriction occurred in the early period after administration of Mannitol. This change was considered to be due to autoregulation of the cerebral vessels.