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Neurological Surgery No Shinkei Geka Volume 33, Issue 2 （February 2005）

Neurological Surgery 脳神経外科 33巻2号（2005年2月発行）

Japanese English

研究

塩酸ファスジル動注効果の持続時間 Intra-arterial Administration of Fasudil Hydrochloride： Duration of Action 小野健一郎 ¹ , 城谷寿樹 ¹ , 和田孝次郎 ¹ , 高原喬 ¹ , 松下芳太郎 ¹ , 弓場孝治 ² , 山名大吾 ² Kenichiro ONO ¹ , Toshiki SHIROTANI ¹ , Kojiro WADA ¹ , Takashi TAKAHARA ¹ , Yoshitaro MATSUSHITA ¹ , Koji YUBA ² , Daigo YAMANA ² ¹自衛隊中央病院脳神経外科 ²三宿病院放射線科 ¹Department of Neurosurgery,Japan Self Defense Forces Central Hospital ²Department of Radiology,Mishuku Hospital キーワード： cerebral vasospasm , fasudil hydrochloride , intra-arterial infusion , perfusion CT Keyword: cerebral vasospasm , fasudil hydrochloride , intra-arterial infusion , perfusion CT pp.133-140

発行日 2005年2月1日 Published Date 2005/2/1

DOI https://doi.org/10.11477/mf.1436100031

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　塩酸ファスジルは脳血管拡張作用を有し，二重盲検試験でくも膜下出血（subarachnoid hemorrhage, SAH）後の症候性脳血管攣縮を30％低下させ有効との結果¹⁵⁾より1995年に認可されて以来，本邦では広く使用されている薬剤である．また攣縮血管に対する動注療法も指田ら，Tachibanaらの報告^14,17)以降，各施設において散在的に使用され，その有効性と副作用の少なさを指摘するものが多い^4,16)．脳血管攣縮に対する動注薬剤として以前より塩酸パパベリンが使用されてきたが，高濃度の薬剤による穿通枝の閉塞や血管壁の損傷がその主体と考えられる散瞳，麻痺，意識レベル低下，呼吸停止といった副作用が報告され^7,13,22)，近年ではさしたる合併症を認めない塩酸ファスジル動注にシフトしてきている^4,16)．しかし塩酸ファスジルの動注至適量，効果持続時間がいまだ不明のまま施行されているのが現状である．そこで本研究の目的は塩酸ファスジルの動注による効果持続時間を明らかにすることである．

Intra-arterial infusion (IA) of fasudil hydrochloride for cerebral vasospasm is performed in many institutions and is associated with few side effects. Nonetheless,as optimum dose and duration of action remain unknown, the present study aimed to clarify these variables. We performed intra-arterial injection of fasudil hydrochloride for eight patients with cerebral vasospasm 7-13 days after subarachnoid hemorrhage. Fasudil hydrochloride was administered via the internal carotid artery without selective microcatheterization,at a concentration and speed of 30 mg/20 ml/10-15 min, using a total dose of 30-60 mg. Cerebral angiography was used to measure change in blood vessel diameter at 19 points, and perfusion CT was used to detect changes in cerebral blood perfusion (CBP), cerebral blood volume (CBV), and mean transit time (MTT) at 12 hemispheres. Investigations were performed before IA, immediately after IA (post IA), and 4.5 to 6 hours later.

　For central vessels,(A1,M1) mean change in diameter (cm) measured pre IA,post IA,and 4.5-6 hours later was 1.2 ± 0.68, 1.5 ± 0.72, and 1.2 ± 0.7, respectively. For peripheral vessels (peripheral to A1, M1, and the ophthalmic artery) change in diameter (cm) was 0.65±0.16, 0.97±0.24, and 0.71±0.24,respectively. Average CBP (ml/100g/min) in the infused hemisphere at pre IA, post IA,and 4.5-6 hours later was 41.6 ± 3.56, 46.4 ± 5.82,41.6 ± 7.42, respectively. Average CBV (ml/100g) was 2.72 ±0.21, 2.73 ±0.21, 2.91 ±0.42, respectively and average MTT (sec) was 5.16 ± 0.38, 4.57 ± 0.70,5.55 ± 1.0, respectively.

　Changes in peripheral vessel diameter and in MTT were statistically significant. Therefore,when performing intra- arterial administration of fasudil hydrochloride,clinicians should be aware that vasodilator effect is less than 6 hours.