28. 手術侵襲の定量化:-各種動脈瘤手術法の酵素学的評価-

概要

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To estimate the causative factors of operative injury by aneurysm surgery, serum creatine phosphokinase activity of brain type was determined electrophoretically during and after operation.<BR>The pre-operative enzyme activity was low enough (0.29±0.26mU/mL) All operated cases were divided into two groups by the peak value of the enzyme activity. One group was named "Mildly Elevated Cases" and another was "Highly Elevated Cases". In the former group, the peak value of CPK-BB activity (1.26±0.58mU/mL, N=30) was lower than that at the time of SAH onset (2.25±1.25 mU/mL, N=14, the cases of Grade III-V).<BR>The site of aneurysm and the difference of operative approach (pterional approach versus interhemispheric approach) were not reflected as the difference of enzyme activity.<BR>In the cases of high pre-operative Grade and with basilar aneurysm, the peak value of CPK-BB activity was markedly high (4.92±1.65 mU/mL, N=19). Regarding the operative technique, brain retraction, brain aspiration, use of temporary clip and the removal of bilateral subarachnoid clot are the main factors which elevate the CPK-BB activity in serum.<BR>Practically, the quantitative evaluation of operative injury is possible by determining the blood sample from 2 to 6 hours after neck-clipping of the aneurysm.
The Japanese Society on Surgery for Cerebral Strokeの論文