Nitroglycerin（GTN）の脳血管攣縮に対する予防効果の検討

Clinical Effect of Nitroglycerin (GTN) on Prevention of Cerebral Vasospasm

　I．はじめに　高度のクモ膜下出血を伴う破裂脳動脈瘤症例において，脳血管攣縮は生命および機能予後に大きな影響を与えるため^12），その予防および治療が重要な課題となっている．

　最近，Ca^＋＋拮抗剤をはじめとする薬物療法^4,22）やウロキナーゼ等による脳槽灌流療法^23）が開発され，臨床に応用されているが，その効果についてはいまだ議論の多いところである．

　今回，われわれは，急性期破裂脳動脈瘤患者に対し，脳血管攣縮の予防を目的として強力な血管拡張剤であるNitroglycerin（商品名：ミリスロール，化学名：Glyce−ryl Trinitrate，以下GTNと略す）の全身投与を行ったので，その効果について報告する．

Abstract

Nitroglycerin (GTN) is widely used as a safe and effective dilator in patients with ischemic heart disease, and it is said that it dilates the cerebral vessels. So the authors are now using GTN for the prevention of cere-bral vasospasm.

125 patients classified as Fisher's Group 2, 3 or 4 were operated on within 72 hours after subarachnoid hemorrhage clue to ruptured cerebral aneurysm. 58 pa-tients (GTN group) were treated with continuous in-travenous infusions of GTN (0.5-1.0ug/kg/min) for about 2 weeks after their operation, and another 67 pa-tients (control group) were not administered GTN. The frequency of occurrence of symptomatic vaso-spasm decreased in each GTN group of Fisher's classi-fication, and the severity of angiographic vasospasm also tended to decrease. Especially in patients with se-vere subarachnoid hemorrhage classified as CT group 3 or 4, symptomatic vasospasm occurred in 11 patients (30.6%) in the GTN group, but in 26 patients (63.4%) in the control group. Regarding the outcome, 10 pa-tients (17.2%) in the GTN group showed poor results or died, as opposed to 22 patients (32.9%) in the con-trol group. This difference was significant. Moreover the GTN group had no cases of mortality due to cerebral vasospasm.

These results indicate that GTN can be effective for prevention of cerebral vasospasm and improve the prognosis in patients with serious subarachnoid hemor-rhage due to a ruptured aneurysm.