脳神経外科におけるDICおよびDIC準備状態に対するFOY療法の有効性の検討

Evaluation of FOY Therapy for DIC or Pre-DIC associated with Neurosurgical Disease

I．はじめに

　脳神経外科疾患を基礎として発症した播種性血管内凝固症候群（以下DIC）およびDIC準備状態の治療に関し，多数例をもとに蛋白分解酵素阻害剤メシル酸ガベキサート（以下FOY）の治療効果を検討した報告は脳神経外科領域では認めない．そこでDICおよびDIC準備状態の患者に対しFOYを投与し，その臨床症状，検査所見の推移を検討しFOYの有効性につき評価を行ったので報告する．

Disseminated intravascular coagulation (DIC) is not a rare phenomenon in the neurosurgical field. We in-vestigated the therapeutic effect of [Ethyl p-(6-gua-nidinohexanoyloxy) benzoate] methanesulfonate (FOY) for DIC or Pre-DIC states associated with neurosurgi-cal disorders.

During the previous three and half years, a total of 52 cases have been admitted to Shinshu University Hospital and its affiliated hospitals with DIC or Pre-DIC states due to brain disorders (group A) associated with head injuries (19 cases), subarachnoid hemor-rhages caused by ruptured aneurysm (12 cases) , in-tracranial hemorrhages and infarctions (5 cases) , arte-riovenous malformations (2 cases) and spinal cord in-jury (1 case), and with those states due to brain and another disorders (group B) associated with infections (7 cases), shocks (2 cases) and intoxications by drugs (2 cases). FOY was administered continuously for all patients. Clinical manifestations and laboratory data were analyzed statistically. Platelet count improved from during the 7th to the 10th day after starting FOY. It improved significantly in cases with a high DIC score and the improvement was not influenced by platelet transfusion. FDP, fibrinogen, prothrombin time and antithrombin-III also improved. DIC score remark-ably improved in cases with an initial high DIC score. Hemorrhagic symptoms were recognized in 19 cases be-fore administration of FOY and 14 of them (74%) im-proved after the treatment. Dysfunction of organs was recognized in 28 cases, of which 5 cases (18%) im-proved. Twenty-nine of 52 cases (56%) were still alive. Only two patients died clue to DIC. There were no side effects associated with administration of FOY. It is concluded that FOY therapy for DIC or Pre-DIC in the neurosurgical field was effective.

FOY has not only inhibitory effects on thrombin, fac-tor Xa, plasmin and kallikrein but also inhibitory effects on production of superoxide, reaction of lipid oxidation and degranulation of mast cells. From the point of view of microcirculation, FOY is expected to be more effective than heparin.