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Neurological Surgery No Shinkei Geka Volume 46, Issue 9 （September 2018）

Neurological Surgery 脳神経外科 46巻9号（2018年9月発行）

Japanese English

研究

脳内出血急性期の血腫吸収過程に対する桂枝茯苓丸の効果および安全性—CT画像を用いた検討 Safety and Efficacy of Keishi-Bukuryo-Gan in Patients with Spontaneous Intracerebral Hemorrhage during the Acute Period:CT Image-Based Analysis of the Clearance of Hematoma 大沢伸一郎 ^1,2 , 遠藤英徳 ² , 川村強 ¹ , 冨永悌二 ² Shin-ichiro OSAWA ^1,2 , Hidenori ENDO ² , Tsuyoshi KAWAMURA ¹ , Teiji TOMINAGA ² ¹八戸市立市民病院脳神経外科 ²東北大学大学院医学系研究科神経外科学分野 ¹Department of Neurosurgery, Hachinohe City Hospital ²Department of Neurosurgery, Tohoku University Graduate School of Medicine キーワード： Keishi-Bukuryo-Gan , Kampo medicine , intracerebral hemorrhage , hematoma clearance , acute phase Keyword: Keishi-Bukuryo-Gan , Kampo medicine , intracerebral hemorrhage , hematoma clearance , acute phase pp.763-770

発行日 2018年9月10日 Published Date 2018/9/10

DOI https://doi.org/10.11477/mf.1436203810

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Ⅰ．はじめに

　脳内出血の内科的治療において，血腫吸収の速度は機能回復過程に影響を与えると考えられる．しかし，実臨床における血腫吸収に影響を及ぼす因子について検討した報告は少ない．桂枝茯苓丸（Keishi-Bukuryo-Gan：KBG）は，東洋医学的な病態（証）である“瘀血”に対して有効とされるが，脳内出血症例には赤ら顔，肥満や高血圧など，本証を示す患者が多い．また，そのほかに皮下血腫に対する吸収促進作用や組織血流改善作用などが報告されているが，頭蓋内疾患に対する効果の報告は稀である．今回われわれは，KBG投与が脳内出血患者において血腫吸収を促進するという仮説を立て，発症急性期よりKBGが投与された症例について，血腫吸収の経過に及ぼした影響を検討した．

　BACKGROUND:Keishi-Bukuryo-Gan（KBG）is a traditional Japanese（Kampo）formula used to improve microcirculation and a congestive condition called “Oketsu”. KBG is also used to prevent the development of atherosclerosis. Many patients with intracerebral hemorrhage（ICH）have comorbid diseases related to atherosclerosis;thus, KBG may be a treatment option for ICH.

　OBJECTIVE:The aim of this study was to investigate whether the administration of KBG in patients with ICH during the acute phase affects the course of absorption of ICH, detected using computed tomography（CT).

　MATERIAL and METHODS:We identified 308 patients with ICH who were diagnosed and treated at our institution from April 2013 to June 2016. Among them, 53 patients were chosen based on the accessibility of CT images, patient background, and past history. The volume and CT value of the hematoma were analyzed at admission, one week（six to eight days）after admission, and two weeks（thirteen to sixteen days）after admission.

　RESULTS:There were no significant differences between KBG and non-KBG patients in terms of the background parameters, hematoma volume, or CT value at admission. However, there were significant differences in both the volume reduction ratio（non-KBG＝64.3±8.4%, KBG＝48.5±14.5%, p＝0.03）and CT value（non-KBG＝48.5±4.6HU, KBG＝44.0±7.0HU, p＝0.04）two weeks after admission.

　CONCLUSION:Significant improvement in the absorption of ICH was observed in KBG patients. To our knowledge, this is the first report that shows the facilitative effect of KBG on intracranial hematoma clearance during the acute phase.