頭部外傷患者におけるMannitol持続少量総頸動脈投与療法

Continuous Intracarotid Infusion of Mannitol to Severe Head Injury

I．はじめに

　高浸透圧利尿剤である20％mannitolは各種頭蓋内圧亢進状態に使用され，その効果も広く知られている．しかしその反面，反跳現象や長期使用による電解質異常あるいは種々の要因によりmannitolを使用しがたい病態も存在する．われわれはこのような患者に対してman—nitol持続少量総頸動脈投与療法（以下mannitol動注療法と略す）を試み，良好な結果を得たので報告する．

The clinical significance of continuous intracarotid in-fusion of a small dose of mannitol (ICI of mannitol) was discussed. Eighteen patients suffering form severe head injury with Glasgow coma scale (GCS) less than 6 were treated by ICI of mannitol for the improvement of raised intracranial pressure (ICP). In all of these 18 cases, con-ventional venous administration of mannitol could not be carried out, because of the unstable vital signs due to hypovolemic shock such as multiple trauma or disturb-ance of serum sodium and potassium levels. This method requires that a 20% mannitol solution be directly and continuously administered to the bilateral common caro-tid artery.

The ICP 6 hours after the beginning of ICI of man-nitol was significantly lower than the ICP just before the treatment. The total amount of excretion of the sodium and potassium through the urine every hour decreased significantly after this method was used. It was also noticed that this method was very suitable for stabilizing the vital signs in cases which had unstable vital signs such as hypovolemic shock. These findings suggested that ICI of mannitol has an advantage over the conventional venous administration of mannitol in cases which had to have correction of serum electrolyte or which had unstable vital signs.