Transcranial Doppler Pattern after Intracarotid Papaverine and Prostaglandin E1 Incorporated in Lipid Microsphere in Patients with Vasospasm
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概要
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We studied the effects of intracarotid papaverine and prostaglandin E1 incorporated in lipid microsphere (Lipo-PGE1) in relation with transcranial Doppler parameters such as mean flow velocity (MFV) and pulsatile index (PI) of the proximal segment of the middle cerebral artery. Eighty patients with subarachnoid hemorrhage (SAH) were included in this study. In the case of angiographic vasospasm, papaverine at 7mg/min with total dose below 300mg per artery and 10-20 μg of Lipo-PGE1 were injected in the supraclinoid portion of the internal carotid artery. Vasospasm was improved in 24 patients (63%), however, it was unchanged in 14 patients (37%). The former patients had more favora-ble outcomes than the latter patients (p<0.005). After intracarotid injection therapy, the correlation be-tween MFV and PI was classified into three types: type 1, both MFV and PI decreased; type 2, MFV decreased but PI increased; and type 3, both MFV and PI fluctuated. The Glasgow Outcome Scale 3 months after SAH was as follows: type 1 (n=15), good in 14 (93%) and moderate disability in one (7%); type 2 (n=9), good in eight (89%) and vegetative state in one (11%); and type 3 (n=14), moderate disability in five (36%), severe disability in seven (50%), and death in two (14%). Chi-square analysis showed significant differences between type 1 and type 3 (p<0.005), and type 2 and type 3 (p<0.005). In conclusion, intracarotid papaverine combined with Lipo-PGE1 was effective for vasospasm but type 3 patients require a different treatment protocol.
著者
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Waga Shiro
Department Of Neurosurgery Kyoto University Medical School
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Kuga Yoshihiro
Department Of Neurosurgery Mie University School Of Medicine
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Nakamura Fumiaki
Department Of Epidemiology And Healthcare Research Graduate School Of Medicine And Public Health Kyoto University
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KAMATA Naoki
Department of Neurosurgery, Mie University School of Medicine
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KANAMARU Kenji
Department of Neurosurgery, Mie University School of Medicine
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