Neurological Surgery 脳神経外科38巻9号

2010年09月発行

総説

重症頭部外傷における脳内microdialysisの応用

著者： 河井信行¹ 河北賢哉¹² 矢野達也¹² 阿部祐子² 黒田泰弘² 田宮隆¹

所属機関： ¹香川大学医学部脳神経外科 ²香川大学医学部救急災害医学，香川大学医学部附属病院救命救急センター

ページ範囲：P.795 - P.809

Ⅰ．は じ め に

　脳内微小透析法（microdialysis：MD）は，脳内に挿入した微小な透析膜カテーテルを利用して，透析の原理により脳組織の細胞外液を採取し，その中の化学物質の濃度を測定する生化学的脳モニタリング法である．透析膜をもつカテーテルを組織内に挿入し，灌流液を介して細胞外液中の化学物質の濃度を測定することは，30年以上前から実験動物において行われてきた．その後1990年代初めからヒトへの応用が開始され^20,25)，新たな脳モニタリング法として急速に発展してきた．近年，簡便な装置の開発と膜素材の改良などにより，合併症を起こさず安全に長期間のカテーテル留置が可能となった．MDにより損傷を受けつつある脳組織の代謝変化を連続的にモニタリングすることで，二次的脳損傷メカニズムの解明，治療法の選択や治療開始時期の決定，治療効果の判定などがベッドサイドで可能である．

　近年，ヒト用のMDカテーテルが本邦でも薬事承認され，神経集中治療領域における臨床応用が開始されている．本稿では，MDの基本的な原理と頭部外傷におけるMDの役割を最近の報告を基に解説し，またわれわれの初期の経験を報告する．

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