SOEJIMA Yoshiyuki Yamaguchi University, Assistant Hospital, 医学部附属病院, 助手 (20206676)
SADAMITSU Daikai Yamaguchi University, Assistant Prof. Hospital, 医学部附属病院, 講師 (10187164)
TATEISHI Akio Yamaguchi University, Associate Prof. Hospital, 医学部附属病院, 助教授 (00155102)
ISHIKAWA Toshizoh Yamaguchi University, Assistant School of Medicine, 医学部, 助手 (90034991)
|Budget Amount *help
¥7,000,000 (Direct Cost : ¥7,000,000)
Fiscal Year 1991 : ¥600,000 (Direct Cost : ¥600,000)
Fiscal Year 1990 : ¥6,400,000 (Direct Cost : ¥6,400,000)
To clarify the pathophysiology of neurological disturbance following cardiopulmonary resuscitation (CPR), cerebral circulation, electroencepharogram (EEG), brainstem auditory evoked response, brain computed tomography (CT)and excitatory or inhibitory amino acid neurotransmitters were measured in human.
Cerebral blood flow, measured by Kety-Schmidt method (n=4), decreased significantly from 46 <plus-minus>7 ml/lOOg/min (mean <plus-minus>SD, n=13) to 31 <plus-minus>8 ml/lOOg/min during 4-8 hours, and returned to 59<plus-minus> 24 ml/lOOg/min during 8-48 hours following CPR. Mean velocity and pulsatility index in the middle cerebral artery following CPR, measured by non-invasive transcranial doppler sonography following CPR, were 81.3<plus-minus>19.7 cm/sec and 0.99 <plus-minus>0.24 in the rheta-delta waves dominant EEG group, while those were 18.5<plus-minus>11.1 cm/sec and 2.2 <plus-minus>1.0 in the delta- flat EEG group. These parameters were significantly different between
Brain CT show
ed no abnormality in two good recovered cases. While low and/or high density areas, and enhanced areas by iopamidol were apparent in basal ganglia and cerebral cortex following CPR in the vegetative or dead cases. Decreased gray-white matter differentiation, effaced sulci, and effacement or dilatation of lateral and cistern ventricles were also appeared.
Excitatory neurotransmitters, i. e. ; aspartate and glutamate which cause neurotoxicity and may trigger, delayed neuronal death, increased significantly from 0.6<plus-minus>0.5 and 1.6 <plus-minus>0.7 mu mol/l (mean <plus-minus>SD, n=16, control) to 3.4 <plus-minus>4.1 and 5.7 <plus-minus>7.1 mu mol/l following CPR (n=ll), respectively. Inhibitory neurotransmitters, i. e. ; taurine and alanine also increased significantly from 5.8<plus-minus>1.9 and 32.0<plus-minus>. 6.5mu mol/l (control) to 13.8 <plus-minus>14.8 and 97.9 <plus-minus>74.8mu mol/l following CPR, respectively. These changes were basically same, when CPR cases were divided into hyperglycemia group (n=5) and normoglycemia group (n=6), and there was no significant difference in the amino acids between these two groups. Aspartate and glutamate were extremely high in one case, who revealed seizure
In the present study, we conclude that cerebral blood flcw decreased transiently. Electroencepharogram, brainstem auditory evoked response and brain computed tomography varied depending on the grade of neurological disturbance. Neuro-excitatory amino acids, which is aspartate and glutamate were increased in cerebrospinal fluid following cardiopulmonary resuscitation with or without hyperglycemia in human. Less