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Shinkei Kenkyu no Shinpo Volume 12, Issue 4 （December 1968）

神経研究の進歩 12巻4号（1968年12月発行）

Japanese English

原著

頭部外傷後遺症の病態生理に関する脳波学的研究—特に星状神経節遮断および大後頭神経遮断を中心として Electroencephalographic Study of Sequelae of Head Injury Treated with Stellate Ganglion Block and Great Occipital Nerve Block 廣岡男也 ¹ D. Hirooka ¹ ¹岩手医科大学第2外科 ¹Dept. of 2nd Surgery, Iwate Medical Univ. pp.1001-1016

発行日 1968年12月25日 Published Date 1968/12/25

DOI https://doi.org/10.11477/mf.1431904568

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Abstract 文献概要
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I．緒言

　いわゆる頭部外傷後遺症患者に対し，星状神経節遮断あるいは大後頭神経遮断が著効を奏する例のあることは既に諸家の報告もあり，またわれわれも日常しばしば経験するところである。しかしこれら治療法の作用機序については未だ明確な説明がなく，しかも頭部外傷に伴う後遺症の発生は多いにもかかわらず，その病態生理に関してはまだ不明な点が多い。一方これら神経遮断による症状軽快の機序を究明することは，治療的立場より後遺症の病態の一部を解明しうるものと考え，著者は脳波を示標とし，神経遮断前後の脳波変動を経時的に観察したところ脳波改善と症状の消長との間に興味ある所見を得た。

　更にこれら神経遮断に伴う脳波変化と脳病態生理との相関を明らかにするため，家兎頸部交感神経，大後頭神経ないし深層項筋の刺激状態をつくり，これを遮断することにより深部脳波の変動を追究し，更にそれらと脳幹循環との相関について検討を加え，頭部外傷後遺症の病態生理の一部を示唆し得る興味ある知見を得たので報告する。

Complaints of the patient with sequelae of head injury have often soothed by the treatment of stellate ganglion block (S.B.) or great occipital nerve block (O.B.). To know the mechanism of these treatments, we took a clinical approachwith the E.E.G. of the patient thus treated, as well as an experimental one.

S.B. was performed on the fifty patients having stubborn complaint from sequelae of head injury and their E.E.G. was taken immediately after the Homer sign appeared. Also, on the fifty patients complaining particularly cervical and occipital pain, the E.E.G. was taken 5 minutes after O.B has been performed.

1. In both E.E.G.s, the favorable cases had the decrease of the fast wave, the increase of the slow a-wave, the normalized potential of the amplitude and a regular rhythm.

2. The outstanding findings were most in 8 mi-nutes in the S.B. treated E.E.G., recorded after the Homer sign appeared, while in 13 minutes after O.B. has been performed.

3. S.B. was efficacious in 37 of the 50 cases (74%), and O.B. in 40 of the 50 cases (80%).

4. Judging from the E.E.G., both blocks were determined efficacious when the fast wave and the fast α-wave with irregular rhythm in low potain-tial or normal potential were present.

5. The appearance of slow a-waves and occa-sional α-waves in high potential with irregular rhythm was an infavorable sign in both E.E.G.s.

6. As the possible factors influencing on the wave pattern, the cerebral circulatory factor, the neurogenic factor and the associated factor of them were considered. Among these, the cerebral circu-latory one can be one of the closest causes of the sequelae, which has been confirmed by investiga-ting wave forms of the E.E.G. and the experimen-tal intracerebral circularoy changes in the oxygen tension by polarography.