| Japanese |
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| Title | アルコール依存症患者における心臓弁膜症手術2症例の経験 |
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| Subtitle | 症例 |
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| Authors | 山本晋, 新見能成*, 細田泰之 |
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| Organization | 順天堂大学胸部外科, *順天堂大学麻酔科 |
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| Journal | 循環制御 |
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| Volume | 12 |
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| Number | 2 |
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| Page | 335-337 |
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| Year/Month | 1991/ |
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| Article | 報告 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | アルコール依存症から離脱する際の症状に振戦せん妄がある. しかし, 離脱期を過ぎた患者が再びせん妄を呈することはまれと言われている1). われわれは, 一旦アルコール依存症より離脱した後, 心臓手術を契機にアルコール離脱症状と思われるせん妄を呈した症例を経験したので報告する. 「症例 1」47歳の男性. 37歳より労作時に動悸が見られ, 44歳で心臓カテーテル検査の結果, 僧帽弁閉鎖不全および肥大型閉塞性心筋症を指摘された. 手術に対する恐怖心からアルコールを多飲するようになり, 急性アルコール中毒で近医に入院となった. 退院後もアルコールの摂取が続きアルコール依存症となったため, 再入院しアルコールの離脱を行った. 同年, 心不全が増悪傾向にあるため当院に入院となった. 入院時, 肝機能・腎機能はいずれも正常であり, 心臓超音波と心臓カテーテル検査・左室造影にて僧帽弁閉鎖不全および肥大型閉塞性心筋症の診断を受け手術適応となった. 麻酔方法は, 麻酔導入45分前にヒドロキシジン50mg, ペチジン50mgの前投薬の後, フェンタニール1.5mg, ジアゼパム20mgで導入を行い, 術中はフェンタニール, ジアゼパムおよび笑気とエンフルレンで維持した. 僧帽弁を25mmのSJM弁にて置換した後, 肥大心筋に対して左室中隔心筋切除を行った. |
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| Practice | 基礎医学・関連科学 |
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| English |
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| Title | Two Alcoholic Patient Who Underwent Operations For Heart Disease |
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| Authors | Shin Yamamoto, Yosinari Niimi*, Yasuyuki Hosoda |
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| Organization | Department of Thoracic Surery Juntendo University School of Medicine, *Department of Anesthesiology Juntendo University School of Medicine |
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| Journal | Circulation Control |
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| Volume | 12 |
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| Number | 2 |
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| Page | 335-337 |
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| Year/Month | 1991/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | We recently experienced two alcoholic patient who underwent operations for heart disease. The first case was a 47 year-old male who had been diagnosed as an alcholic 10 years previously. He underwent mitral valve replacement based on a diagnosis of mitral requrgitation. Anesthesia was induced by fentanyl and diazepam and maintained with fentanyl, diazepam and GOE. Diazepam and morphine were used for postoperative sedation. Because the patient was restless, he was administered 35 mg of diazepam, 25 mg of morphine, 1250 mg of thiopental and 23 mg of haloperidol 24 hours after entering the ICU. Restlessness and insomnia continued until the 5th day, but his mental symptoms improved after he was moved from the ICU to an ordinary ward. The second patient was a 48 year-old male who was diagnosed as having mitral stenosis and regurgitation, but refused surgery. His fear of surgery rexulted in worsening of his alcholism and he was hospitalized. Since he was considered to have undergone alcoholic withdrawal, mitral valve replacement was performed. Postoperatively, he showed hypotension associated with violent body movements. Restlessness and insomnia continued and he was given intravenous injection of 10 mg of diazepam and 100 mg of thiopental every 3 hours at night. |
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| Practice | Basic medicine |
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