急性重症頭部外傷にみられる酸塩基平衡の異常

ALTERATIONS IN ACID-BASE BALANCE IN ACUTE SEVERE HEAD INJURY

I．はじめに

　長時間昏睡をつづけるような急性重症頭部外傷の中には，数日から数週を要して漸次快方に向かうものから，高度の呼吸障害をきたしたり，あるいはその状態から短時間のうちに呼吸停止におちいり，ついには死亡してゆくものまで，種々の程度のものがある。

　私どもはこのような症例の末梢動脈血・血液ガス分析を行ない，酸塩基平衡（以下A．B．B．と略記する1について二，三の知見を得たので報告する。

Arterial blood gas analysis was carried out on 16 patients of acute severe head injury who were in coma over 24 hours. The results in variable stage were summarized to study the acid-base balance in each case.

(1) There was a remarkable difference of acid-base balance in first 48 hours following the injury or the beginning of coma between those who survived and those deceased.

(2) In early stage of injury, many were in res-piratory alkalosis accompanied with the tendency to the compensatory deficit of buffer base.

In those where this base deficit stayed within nor-mal range and was followed by the metabolic alkalo-sis in about the fifth day of injury, recovery was the rule.

However, those who showed a remarkable base deficit even in early stage of the injury, followed by the progressive decrease of pH in the course of the next 3 to 4 days, were all fatal.

(3) In those who had the base deficit, intravenous injection of 7% Sodium Bicarbonate was effective.

In some, improvement was observed even in neu-rological state.

Required amount of correcting agent was not al-ways in accord with usual calculation of 0. 2 × body weight × mEq. per liter of base deficit.

Some were effective only with one third to two fifth of this amount.