Barbiturate療法における全身合併症の問題点と対策

Problems in General Management during Barbiturate Therapy

I．はじめに

　現在，重症頭部外傷，脳血管障害などの治療にあたり頭蓋内圧亢進対策，脳代謝機能保護などを目的としてbarbiturate（BA）り寮法を施行する機会に少なからず遭遇する．しかし，導人時および長期間施行中に発生する種種の全身合併症が原疾患の予後を増悪させることも稀ならず経験するにも拘らず，BA療法の実施にあたって確立された具体的な方法は示されていないのが現状である．今回，著者らはBA療法に伴って生じた全身介併症に関しその要因を追究し，予防を含めた対策を検討した．

Sixty-three patients (aged from 4 to 75 years) who had suffered severe head injury or cerebrovascular dis-ease were placed on barbiturate regimens in which in-travenous administration was given in amounts of 1 - 4 mg/kg/hr. Dobutamine and dopamine were also admi-nistered to prevent cardiac failure and renal failure. Im-mediate and delayed complications caused by barbitu-rate therapy were investigated and analyzed. Immediate complications included tachycardia which was seen in 16 cases (25%), and hypotension in 14 cases (22%), re-spectively. Higher incidence of those complications was noted among the patients who underwent surgery. De-layed complications included hypokalemia (41 cases, 65%), liver dysfunction hypernatremia (24 cases, 38%), infection (21 cases, 33%), cardiac failure (8 cases, 13%) and renal failure (1 case, 2%), respectively. Therefore, in patients treated under barbiturate regimens great care should be taken in order to avoid above mentioned complications.