Neurological Surgery 脳神経外科45巻10号

2017年10月発行

研究

頚動脈ステント留置術後の過灌流症候群予測における両側rSO₂モニタリングの有用性

著者： 新美淳¹² 石原正一郎³ 塚越瑛介² 根木宏明² 掛樋善明² 上宮奈穂子³ 溝上康治² 石原秀章² 神山信也² 山根文孝²

所属機関： ¹船橋市立医療センター脳神経外科 ²埼玉医科大学国際医療センター脳血管内治療科 ³埼玉石心会病院脳神経外科

ページ範囲：P.859 - P.867

Ⅰ．緒　　言
　頚動脈狭窄症に対するステント留置術（carotid artery stenting：CAS）は，頚動脈内膜剝離術（carotid endarterectomy：CEA）とともに，現在では確立した治療法である^3,6,26)．その周術期管理においては，虚血性合併症のみならず過灌流症候群（cerebral hyperperfusion syndrome：CHS）に十分注意する必要がある．CEA術後の過灌流症候群は1981年にSundtら²³⁾によって報告され，その発症率は0.2〜18.9%と報告されている²⁵⁾．CAS術後の過灌流症候群は，1990年代後半から報告され始め^2,15,17)，0.4〜11.7%に発症し，頭蓋内出血を来す例は0〜11.7%と報告されており，ひとたび頭蓋内出血を来すと致死的となり得る^1,4,9,11)．
　CASおよびCEA術後の過灌流症候群の予測および早期発見のために，positron emission tomography（PET），single photon emission computed tomography（SPECT），transcranial Doppler（TCD），transcranial color-coded real-time sonography，computed tomography perfusion（CTP）などの有用性が報告されている^{4,10,11,13,21,24,25)}．近年は，近赤外線分光法（near-infrared spectroscopy：NIRS）を用いた局所混合血酸素飽和度（regional saturation of oxygen：rSO₂）モニタリングの有用性に関する報告が散見されるようになってきた^8,14,19,21)．rSO₂モニタリングは非常に簡便かつ低侵襲，低コストである．また，術中から術後まで持続的にモニタリングが可能であり，リアルタイムに頭蓋内血流動態の変化を捉えることができる^7,8,21)．これまでのrSO₂モニタリングの報告は，患側値のみの変化に注目しているものが多いが^8,14,19,21)，rSO₂はそのベースラインの個人差が大きく，さらに周術期においては酸素投与や血圧変動などにより計測値が変動しやすいため^7,12,16,22)，その値の解釈には注意を要する．

参考文献

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