著者

長谷川 久弥 川暗 一輝 井上 壽茂 梅原 実 高瀬 真人

出版者

日本小児呼吸器疾患学会

雑誌

日本小児呼吸器疾患学会雑誌 (ISSN:09183876)

巻号頁・発行日

vol.19, no.1, pp.80-84, 2008-06-30 (Released:2011-06-07)

参考文献数

8

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先天性中枢性肺胞低換気症候群 (オンディーヌの呪い, 以下CCHS) は睡眠時に低換気を呈する稀な疾患である。今回, 本邦におけるCCHSの実態把握のため, 全国アンケート調査を施行した。23施設から37例のCCHS症例の回答が得られた。主な結果は以下の通りである。症例背景: 男児18例, 女児19例, 在胎週数39.2±2.1, 出生体重2917±360g, 年齢4ヶ月-34歳。診断方法: 臨床症状37/37 (睡眠時低換気37/37, 覚醒時低換気9/37), 血液ガス分析25/37, 炭酸ガス換気応答14/37, 遺伝子解析 (PHOX2B) 13/37。合併症: Hirschsprung氏病13/37, 中枢神経合併症15/37, 他。転帰: 病院内死亡3/37, 入院中1/37, 在宅人工換気33/37 (死亡4/33, 施行中29/33), 治癒0/37。呼吸管理法: 気管切開21/37, 鼻マスク9/37, フェースマスク5/37, 横隔膜ペーシング1/37。今回の検討で本邦におけるCCHSの現状を把握することができた。CCHSの診断, 管理等は様々な方法が行われており, 統一されたものはなかった。今後, 症例の蓄積をすすめ, 適切な診断, 管理法を検討していく必要があるものと思われた。

著者

倉持 笑子 山田 洋輔 長谷川 久弥 丸田 沙也香

出版者

東京女子医科大学学会

雑誌

東京女子医科大学雑誌 (ISSN:00409022)

巻号頁・発行日

vol.93, no.2, pp.57-61, 2023-04-25 (Released:2023-04-25)

参考文献数

7

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Background: Surfactants are produced sufficiently after 34 weeks of gestation as the fetal lungs mature. The stable microbubble test (SMT) evaluates fetal lung maturity. However, late preterm infants sometimes present with severe respiratory distress and require appropriate respiratory care.Methods: We reviewed 42 late preterm infants who underwent the SMT with gastric aspiration upon admission to our neonatal intensive care unit. The gestational age was 35.3 (34.6-36.0) weeks, and the birth body weight was 2,181 (1,971-2,527) g. We classified the patients into the premature and mature groups based on the results of the SMT. We investigated the results of the SMT in late preterm infants and compared lung maturity with the maternal and neonatal respiratory clinical courses.Results: There were 12 infants in preterm group (28.6%). The gestational age of the premature group was significantly longer, and the Apgar scores were lower in the premature group. Mothers of the premature group had significantly more cases of gestational diabetes mellitus. Respiratory distress syndrome was significantly more frequent, and infants in the premature group required invasive ventilation more frequently.Conclusions: We found that a small number of neonates produced sufficient surfactant, even in late preterm infants. It is suggested that the production of surfactants is related to gestational diabetes mellitus more than gestational age, and the SMT is useful in late preterm infants.

著者

長谷川 久弥

出版者

東京女子医科大学学会

雑誌

東京女子医科大学雑誌 (ISSN:00409022)

巻号頁・発行日

vol.87, no.Extra1, pp.E35-E39, 2017-05-31 (Released:2017-07-31)

参考文献数

8

被引用文献数

1

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Laryngomalacia is the most common cause of inspiratory stridor in infancy. Obstruction and stenosis of the larynx during inspiration cause symptoms such as inspiratory stridor and obstructive apnea. Diagnosis is made by bronchoscopy, and depending on the lesion it is classified into 3 types. Type 1 is caused by prolapse of mucosa overlying the arytenoid cartilages, Type 2 is caused by foreshortened aryepiglottic folds, and Type 3 is caused by posterior displacement of the epiglottis. In most cases, no special treatment is necessary and the disease will resolve naturally in about a year. In some severe cases, conservative management may become difficult due to symptoms such as feeding difficulty, poor weight gain, breathing difficulty and obstructive apnea, and aggressive treatment may become necessary. Examples of aggressive therapy are laryngoplasty for Types 1 and 2 laryngomalacia, and epiglottopexy for Type 3 laryngomalacia. In this paper, diagnosis and treatment of laryngomalacia will be discussed.