急性薬物中毒症例の意識回復過程と聴性脳幹反応，温度眼振反応，アブミ骨筋反射—Nitrazepam Chlorpromazine中毒の1例

Auditory Brain Stem Respose, Caloric Reaction and Stapedial Reflex in a Comatose Patient due to Intoxication of Netrazepam and Chlorpromazine

　I．はじめに

　意識障害の診断にあたっては，意識の調節が脳幹網様体を中心に行われるために脳幹の機能検査がとくに重要となる。急性期の意識障害の脳幹機能の指標として，聴性脳幹反応^1），温度眼振反応^2）などが利用されているが，同じく脳幹の反応の一つであるアブミ骨筋反射^3）は，まだ利用されることが少ないようである。

　われわれは，自殺を目的とし，nitrazepam，cholrpromazineを多量に服用した症例の意識回復過程を上記の脳幹の起源を持つ3つの反応でモニターを行った。その結果，温度眼振反応とアブミ骨筋反射が，血液を体外循環して直接吸着剤と接触させ，血中の有害物を吸着除去するdirecthemoperfusion（DHP）^4）後をこ，著明な改善が認められたので報告し，いずれの脳幹機能検査が薬物中毒例では参考になるか検討することにした。

　A 33-year- old woman who failed in committing suiside by taking excessive dose of netrazepam and chlorpromazine was evaluated for her comatose state. The depth of unconsciousness was monitored by auditory brain stem response, caloric reaction, and stapedial reflex. For treatment of her comatose state, direct hemoperfusion (DHP) was performed to remove the toxic substances from her blood.

　On the first hospital day, ABR was normal but both caloric reaction and stapedial reflex were diminished. With repetition of DHP, both caloric reacion and stapedial reflex were improved gradually and finally became normal. These findings suggest that stapedial reflex and caloric reaction are useful indicators of the brain stem function in comatose patients due to sedative intoxication.

　After DHP twice, she recovered from comatose state and was discharged on the third hospital day.