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Neurological Surgery No Shinkei Geka Volume 21, Issue 5 （May 1993）

Neurological Surgery 脳神経外科 21巻5号（1993年5月発行）

Japanese English

研究

スパスムに対する血漿増量・高心拍出量療法における，血漿希釈と濃縮の指標としての血清膠質浸透圧の測定 Measurement of Serum Colloid Oncotic Pressure as a Parameter of Hemodilution and Hemoconcentration in Hypervolemic: Hyperdynamic Therapy for Symptomatic Vasospasm 戸根修 ¹ , 伊藤梅男 ¹ , 富田博樹 ¹ , 正岡博幸 ¹ , 富永勉 ¹ Osamu TONE ¹ , Umeo ITO ¹ , Hiroki TOMITA ¹ , Hiroyuki MASAOKA ¹ , Ben TOMINAGA ¹ ¹武蔵野赤十字病院脳神経外科 ¹Department of Neurosurgery, Musahino Red Cross Hospital キーワード： Subarachnoid hemorrhage , Cerebral vasospasm , Brain edema , Hypervolemic-hyperdynamic therapy , Oncotic therapy Keyword: Subarachnoid hemorrhage , Cerebral vasospasm , Brain edema , Hypervolemic-hyperdynamic therapy , Oncotic therapy pp.437-441

発行日 1993年5月10日 Published Date 1993/5/10

DOI https://doi.org/10.11477/mf.1436900646

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Abstract 文献概要
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I．はじめに

　クモ膜下出血よる症候性脳血管攣縮に対し，われわれは血漿増量・高心拍出量療法を行っている^3）．この治療法は血漿を増量し，β—stimulantにより心拍出量を治療前の1.5倍以上に増加させて，脳血流量を増加させることを目標としている．しかしながら，この治療にもかかわらず，遅発性脳梗塞が発症して脳浮腫が生じた場合，あるいは元々合併する脳内血腫により脳浮腫が合併している場合，血漿を増量しつつも脳浮腫の治療を同時に行わなければならない．このような場合われわれは，血漿の膠質浸透圧（COP）を上昇させる膠質浸透圧療法を併用することによって脳血管攣縮の時期を切り抜けている．

　今回，血漿増量・高心拍出量療法を行った症例で，血漿増量による循環血漿の希釈と，膠質浸透圧療法の血漿濃縮の指標として，血清膠質浸透圧を経時的に測定し，その有用性を検討した，

Nineteen patients, who developed symptomatic vaso-spasm clue to subarachnoid hemorrhage, were treated by hypervolemic-hyperdynamic therapy. The object of this treatment was to increase cardiac output and cerebral blood flow as a result of hypervolemia and the admini-stration of β-stimulants. During the treatment, if cerebral infarction occurred followed by brain edema, we applied oncotic therapy. As the parameters of therapy, we mea-sured serum colloid oncotic pressure and cardiac func-tions in all of these patients.

Nineteen patients were divided into two groups : group A, 9 patients, who did not develop brain edema, and group B, 10 patients, who developed brain edema. All patients underwent acute neck clipping surgery and plasma volume expansion by the infusion of albumin and/or low molecular weight dextran (LMWD). If symptomatic vasospasm occurred, a Swan-Ganz catheter was inserted and cardiac output was measured until it increased.to 1.5 times the value of pretreatment. In group B, we also used oncotic therapy, raising serum oncotic pressure higher than 25 mmHg by increas-ing the amount of albumin and/or LMWD and admi-nistering furosemide.

By this treatment, the percentage of patients who showed neurological improvement in at least one deficit was 100% in group A, and 89% in group B. In Glasgow outcome scale scores, 89% of group A and 70% of group B had disability not lower than moderate. Serum colloid oncotic pressure was maintained at around 20 - 25mmHg in group A, and 25 - 30mmHg in group B. Although pulmonary artery diastolic pressurein group B tended to be lower than that in group A, car-diac indices in both groups were high, approximately 5.0 L/min/m2.

With measurement of serum colloid oncotic pressure, volume expansion therapy can be safely administered.Furthermore, serum colloid oncotic pressure is a good parameter for oncotic therapy of brain edema due to cerebral vasospasm.