急性大動脈解離Stanford B型症例に対し，経皮吸収型β1選択性β-blocker bisoprololが急性期血行動態に非常に有用であった1例

A Case Report, the Usefulness of the Percutaneous Absorption-type β1-selective β-blocker for a Case of Acute Aortic Dissection

要旨　今回，急性大動脈解離Stanford B型を発症した67歳男性に対して，経皮吸収型β₁選択性β-blockerを投与し，血圧管理に非常に有用であった．本症例は，急性大動脈解離Stanford B型の合併症による上腸間膜動脈の閉塞に伴う小腸虚血を併発し，小腸切除術が行われ，術後短腸症候群による経口摂取困難となった．経口内服薬の投与が困難となり，発症後急性期のみでなく，慢性期の血圧，心拍管理に経皮吸収型β₁選択性β-blocker，ビソノ^®テープの投与量を調整することにより，心拍数，血圧は容量依存的に低下し，目標血圧の管理可能であった．

　本症例のように，血圧，心拍数管理を行う際，経口摂取困難な周術期の症例，また，嚥下障害などにより経口摂取が制限された症例に対して，経皮吸収型薬剤は非常に有用な薬剤である．

　急性大動脈解離Stanford B型症例の急性期保存的治療における血圧，心拍管理においてビソノテープが新たな選択肢の一つとなることが示唆された．

When a percutaneous absorption-type β₁-selective β-blocker was administered to a 67-year old male patient who showed acute Stanford type B aortic dissection, it was very useful for management of blood pressure. This patient was complicated with intestinal ischemia associated with occlusion of superior mesenteric artery due to a complication of acute Stanford type B aortic dissection. He underwent small bowel resection, and oral ingestion became difficult due to short bowel syndrome postoperatively. It became difficult to administer oral drugs, and by controlling the blood pressure and heart rate not only in the acute phase after the onset but also in the chronic phase. And adjusting the dose of a percutaneous absorption-type β₁-selective β-blocker, Bisono tape, the heart rate and blood pressure decreased dose-dependently, and the patient was managed at the target blood pressure.

For the patients in the perioperative phase, with difficulty in oral ingestion such as this case and patients for whom oral ingestion is restricted due to dysphagia, the drugs of percutaneous absorption type are very useful for management of blood pressure and heart rate. A percutaneous absorption-type β₁-selective β-blocker, bisoprolol, is a useful drug for treatment of heart failure, and additional indication for heart rate is desired in addition to blood pressure control in the future.