小児の肥大口蓋扁桃による肺高血圧症と右心肥大

Hypertrophied tonsils as a cause of pulmonary hypertension and cardiomegaly in a child

　小児における肥大した口蓋扁桃（以下扁桃）やアデノイドは，低換気を持続させ肺高血圧症や右心肥大，うつ血性心不全，肺水腫など循環系の障害をもたらすことがある。

　心電図上で肺性Pと右心肥大といった肺性心の初期症状を示し，低酸素血症と高炭酸ガス血症のあった女児に対し，扁桃摘出術を行い全身状態の劇的な改善をみた。手術前後1年あまりにわたって調査した呼吸機能の結果は，上気道閉塞がいかに患者の生命をおびやかしていたかを物語っている。

A 6-year-old obese girl suffering from somnol-ence, breathing irregularities with apnea and cyanosis during sleep, secondary to tremendous tonsils are presented. At 7 years of age, pul-monary hypertension and cardiomegaly, hypoxe-mia and CO₂ retension developed, she underwent right tonsillectomy.

Four days after that, values of Pa_O2, Pa_CO2 forced vital capacity, peaked expiratory flow and ventilatory response to carbon dioxide were im-proved but not normal. Eight months following the operation, these values showed normal, fur-ther peaked P waves in lead II has disappeared and the right ventricular hypertrophy was much less marked in severity. Remarkably she did well physically and mentally.