くも膜下出血後の脳血管攣縮に対する携帯型注入ポンプシステムによるニカルジピン持続髄注療法

Continuous Intrathecal Administration of Nicardipine Using a Portable Infusion Pump System for Management of Vasospasm after Subarachniod Hemorrhage

I．はじめに

　今回われわれは，くも膜下出血患者の術後に，携帯型ディスポーザブル注入ポンプシステムを用いて薬物を簡便に髄腔内投与する方法（以下，本法）を試みた．本法では1回の手技で約8日間分の薬液がセット可能である．2週間の投与メニューの場合には，手術室でセットした後は，病棟では8日目に1回だけ薬液を補充すればよく，手技はきわめて簡便である．また，病室での患者体位に制限が少ないため日常管理も容易である．今回5例のくも膜下出血患者に，脳血管攣縮の予防を目的としてニカルジピン持続髄腔内投与を行ったので，その有用性や問題点について報告する．

We studied the feasibility of intrathecal nicardipine administration using a portable infusion pump sys- tem in five cases (two males and three females) of subarachnoid hemorrhage (SAH). All of the five casesmanifested severe SAH of Hunt & Kosnic grade 3 or 4,and Fisher CT group 3. Aneurysmal sites of five cases were as follows : three internal carotid-posterior communicating artery (IC-PC) aneurysms and two anterior communicating artery (Acom) aneurysms. The container of the infusion pump system was filled with 105 ml of nicardipine-saline solution (2:1), and this system was connected to the cisternal tube. Thesolution was continuously injected at a daily closeof 12 ml (8 mg of nicardipine). This therapy wascon-tinued for 19 clays, and new nicardipine solutionwas supplied only once at 8 days after the operationdur-ing this therapy. No postural restraint of patientswas necessary, even during physical movement for re-habilitation. Postoperative angiography wasperformed in three of five cases at one week afterthe opera-tion. No angiographic vasospasm was observed in anyof the three cases. Symptomatic vasospasm wasobserved in one case of right IC-PC aneurysm as atransient total aphesia and right hemiplegia, whichre-covered within several hours due to inducedhypervolemia and hypertention therapy. Mildmeningitis at 14days after the operation complicated this treatmentin one case, but it improved in a few clays afterthe cis-ternal tube was removed. It was speculated thatmeningitis was caused by cerebrospinal fluid leakagefromthe scalp exit site of the cistemal tube. All of thefive cases had obtained good recovery at threemonthsafter the operation. These results show that,although this method involves a risk of infection,it has theadvantage of easiness and convenience overconventional methods. Though further improvement ofthismethod is required, this preliminary stage ispotentially useful for delivering not onlynicardipine, but alsofor other drugs which may be used in intrathecaladministration therapy.