36. 脳血管攣縮に関する実験的臨床的研究

-とくに Vitamin C の効果について-

抄録

Experimental investigation was performed on oxyHb induced vasospasm (VS) and on effect thereon of ascorbic acid (AsA) pretreatment. Following results were obtained.1) AsA was found to inhibit lipid peroxidation significantly in incubated erythrocyte suspension. It also inhibited auto-oxidation of oxyHb in hemolyzed fluid. 2) Amount of hemolysis, which occured in erythrocyte suspension during 3 day's incubation, was decreased by pretreatment with AsA. 3) Vasoconstricting activity of incubated hemolyzed fluid by AsA pretreatment was reducted significantly. 4) AsA was found to facilitate non-oxidative degradation of oxyHb.
The degradation was supported to proceed from protoheme, through choleheme to verdoheme. Clinical trial on prevention and relief of postoperative VS was justified on account of above experimental results 56 patients with aneurysmal rupture were operated during last year, were devided in 3 groups. 17 patients operated after day 15 (the day of haemorrhage was day 1) into Group 1, 15 patients operated within day 4 without intracisternal AsA administration into Group 2, 24 patients operated within day 4 with intracisternal AsA administration were classified in Group 3 respectively. Effect of intracisternal AsA administration ws appreciated from standpoints of pre and postsurgical CT (clot score), carotid angiogram (Grade of VS) and surgical result one month later (ADL). Surgical result and grade of VS were more favorablein Group 3 than Group 2. Intracisternal AsA administration to the patients, who have been detected high clot score in postsurgical CT, seems to be more reasonable and effective in particular.