綾田 好秀 香川医科大学, 医学部, 助手 (70243756)
TAKAHASHI Norihiko Kagawa Medical School, Second Department of Internal Medicine, Research Associat, 医学部・附属病院, 助手 (70253268)
MATSUO Hirohide Kagawa Medical School, Second Department of Internal Medicine, Professor, 医学部, 教授 (90028514)
|Budget Amount *help
¥2,100,000 (Direct Cost : ¥2,100,000)
Fiscal Year 1994 : ¥800,000 (Direct Cost : ¥800,000)
Fiscal Year 1993 : ¥1,300,000 (Direct Cost : ¥1,300,000)
Antiefema therapy with infusions of hyperosmolar solution is widely available for the treatment of cerebral edema in acute cerebral infarction.However, the mechanisms of antiedema therapy with hyperosmolar solution to improve the secondary disturbances of cerebral circulation, brain energy metabolism, and hemorheology caused by the formations of cerebral edema in acute cerebral ischemia have not been investigated up to the present time.Therefore, we investigated objectively the blocking mechnisms of antiedema therapy with hyperosmolar solution to the secondary disturbances of cerebral circulation and metabolism due to formations of cerebral edema in acute cerebral ischemia by evaluations of sequential changes in cerebral circulation observed by SPECT,clinically, in cerebral energy metabolism observed by P-31 NMR spectroscopy, experimentally, and in hemorheological parameters.We quantified the volume of infaction in acute cerebral embolism, and investigated the correlations between the
infact volume and an asymmetry index (AI), caluclated from cerebral I-123 IMP uptake in the regions of interest set symmetrically in both cerebral hemispheres of patients.The infact volume and AI showed significant linear correlations in patients with acute cerebral emolism.The outcome of survivals in patients with acute cerebral embolism showed significant differeces with the infarct volume of more than 300 ml or of less than that Patients showed persistent increases in hemorheological parameters up to the chronic stage of cerebral infarctions.We evaluated sequential changes of cerebral energy metabolism with P-31 NMR spectroscopy by infusions of hyperosolar solutions of glycerol or mannitol, or saline in cerebral ischemia produced by occlusions of bilateral common carotid artery and reperfused thereafter in Mongolian gerbils.Sequential changes of brain energy metabolism were evaluated.
Significantly higher brain pH was observed 2 hours after reperfusion in the group treated by mannitol than those treated by glycerol or saline.The ratios of phosphocreatin/inorganic phosphate were higher significantly in the groups treated by glycerol 6 hours after reperfusion, and treated by mannitol 8 hours after reperfusion, than treated by saline.The ratios of beta-ATP/inorganic phosphate were also higher significantly in the group treated by glycerol 6 hours after reperfusion than those treated by mannitol or saline.In summary, significant improvements of cerebral energy metabolism were found by infusions of hypersmolar solusions in acute cerebral ischemia, experimentally.
更に実験的研究に関しては脳内エネルギー代謝の回復過程の経時変化の検討は両側総頸動脈閉塞砂ネズミ・モデルにおいて10% glycerol溶液,20% mannitol溶液,あるいは生食を注入しP-31 NMR spect-roscopyにより脳内pH,PCr/Pi比,β-ATP/Pi比の各脳内エネルギー代謝パラメーターの変化を経時的に追跡した所、脳内pHはmannitol群で再灌竜流2時間後でのみ他群に比し高値を示し(p<0.05),PCr/pi比はglycerol群では再灌流6時間後に,mannitol群では8時間後に生食群より高値を示した(各々p<0.05,p<0.01)また,β-ATP/Pi比はglycerol群において再潅流6時間後にmannitol群や生食群より高値を示した(各々p<0.05,p<0.01).以上より実験的脳虚血急性期において高張液投与による脳内エネルギー代謝の有意の改善を確認した. Less