くも膜下出血後の脳血管攣縮に対するNicardipine大量持続投与の効果

High Dose Nicardipine Therapy for Delayed Cerebral Vasospasm after Aneurysmal Subarachnoid Hemorrhage

I．はじめに

　近年，くも膜下出血後の脳血管攣縮に対し，highdose nicardipine（NIC）持続静注投与にて良好な成績が報告されている^{2,3,5-9,11）}．今回，33例のくも膜下出血（SAH）についてNICのhigh dose持続静注を行った．

　これにより，まず第一に症候性脳血管攣縮は1例（3％）にしか認められなかった．第二に，くも膜下出血発症後遅発性脳血管攣縮発生期に搬入された患者において，血管撮影上著明な血管攣縮が3例にみられたが，待期手術にせず，NICを術前もしくは後直後より投与しながら手術を行った結果，症候性脳血管攣縮への移行は認められず，かつ，術後の血管撮影上著明な改善がみられた．本論文では，33例の成績報告と，第2の点について3例の症例報告を行い，NICの遅発性脳血管攣縮の予防的治療としてのhigh dose投与の有効性について検討した．

The effect of high dose nicardipine on delayed cere-bral vasospasm was studied in 33 patients with aneurys-mal subarachnoid hemorrhage (SAH). Intravenous infu-sion of nicardipine started before or immediately after early operation. The dosage was from 4 to 10mg/h with an average of 7.4mg/h. The duration was from 2 to 17 days with an average of 12.3 days.

Symptomatic vasospasm was observed in only one (3%) out of 33 patients. The remaining 32 patients (97%) showed neither ischemic symptoms nor low-density areas on computed tomography. Severe angiographical vasospasm was diagnosed in 3 patients, who entered hos-pital on clay 3 to 5 after initial attacks. They were oper-ated upon on day 4 to 6 under the administration of nicardipine before or immediately after the operation. No patients showed symptomatic vasospasm and angio-graphical vasospasm was improved markedly.

The present study demonstrated that high dose nicar-dipine appeared to prevent both brain ischemia and angiographical vasospasm after aneurysmal SAH.