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Brain and Nerve No to Shinkei Volume 45, Issue 9 （September 1993）

Brain and Nerve 脳と神経 45巻9号（1993年9月発行）

Japanese English

原著

急性頭蓋内圧亢進時のTranscranialDoppler Sonography—実験モデルからみたPulsatility indexの有用性 Transcranial Doppler Sonography in Acute Intracranial Hypertension Model : Usefulness of pulsatility index 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 , 戸田啓介 ¹ , 鵜殿弘貴 ¹ Katsuhiko Harada ¹ , Takashi Hayashi ¹ , Shigetaka Anegawa ¹ , Ryuichiroh Torigoe ¹ , Nobuaki Nishio ² , Takumi Moriyama ³ , Keisuke Toda ¹ , Hirotaka Udono ¹ 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 ²Department of Neurosurgery, Syakaihoken Tagawa Hospital ³Department of Neurosurgery, Fuchu Keijinkai General Hospital キーワード： transcranial Doppler sonography , pulsatility index , intracranial hypertension , autoregulation Keyword: transcranial Doppler sonography , pulsatility index , intracranial hypertension , autoregulation pp.851-856

発行日 1993年9月1日 Published Date 1993/9/1

DOI https://doi.org/10.11477/mf.1406900533

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Abstract 文献概要
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　サルの急性頭蓋内圧（ICP）亢進モデルにおいて，Transcranial Doppler（TC2-64）を使用し中大脳動脈平均血流速度（MCA-FV）とPulsatility index（PI）を測定した。そして，それらの測定がICP亢進時における脳血流障害の判定指標としてどの程度有用か，にっいて検討した。11頭のICPとMCA-FV，脳灌流圧（CPP）とMCA-FVの関係では，いずれも有意の相関性（p＜0.01，p＜O.O1）をみた。7頭のPIとICP，PIとCPPの関係でも，ともに有意な相関性（p＜0.01，p＜0.01）がみられた。そして，ICPが80mmHg以上，CPPで60mmHg以下でPIの顕著な上昇がみられた。この結果，MCA-FVやPIの値からICPやCPPの絶対値を判定することはできなかった。しかし，MCA-FVに影響を与える因子に留意しつつ持続的に測定すれば，ICP上昇時の頭蓋内循環動態の変化を知り得ると考えられた。また，PIの測定はautoregulationの下限（CPPで40-60mmHg）を知るうえで有用であると考えられた。そして，それはPIで1.0〜1.2に相当すると思われる。

The authors studied intracranial hemodynamics in experimental animals (Macaca Fuscatus) with acute intracranial hypertension by use of trans-cranial Doppler (TCD) ultrasound. The blood mean flow velocity in the middle cerebral artery (MCA-FV) and pulsatility index (PI) was recorded using TCD ultrasound (TC2-64, EME) as in the clinical study. Acute intracranial hypertension was produced to determine the correlation of MCA-FV with intracranial pressure (ICP) and cerebral per-fusion pressure (CPP) in 11 monkeys, and the corre-lation of PI with ICP and CPP in 7 monkeys. ICP was elevated by infusing 0.1-0.2 ml/min of saline into the balloon using infusion pump. ICP was raised until maximum level. Changes of MCA-FV, PI, ICP and CPP were evaluated until the CPP of 0mmHg.

There was a significant correlation between MCA -FV and ICP (p＜0.01) as well as between MCA-FV and CPP (p＜0.01) in all 11 monkeys. There was also a significant correlation between PI and ICP (p＜0.01) and between PI and CPP (p＜0.01) in 7 monkeys. PI increased markedly when ICP was 80mmHg or greater or when CPP was 60mmHg or less. ICP was always above 80mmHg when PI was above 1.2. All PI values were above 1.0 when CPP was 40mmHg or less.

Thus, we could not estimate the absolute values of ICP or CPP from MCA-FV and PI. It seems possible, however, to follow changes in intracranial hemodynamics at the time of increased ICP if MCA -FV and PI are measured continuously while paying attention to factors influencing MCA-FV. In addi-tion, these results show that determining PI may be very valuable in finding out the lower limit of auto-regulation corresponding to CPP of 40-60mmHg, and PI of 1.0-1.2 may indicate such a limit.