フルスルチアミンの急性効果を検討しえた脚気心の1例

A Case of Beriberi Heart:With Special Reference to the Rapid Effect of Fursultiamine on Hemodynamics

　フルスルチアミンの急性効果を検討しえた脚気心例を経験した．症例は33歳男性．昭和63年6月失業後食生活が不規則となり，平成元年2月，動悸，息切れ，全身浮腫にて入院．深部腱反射消失，振動覚低下．血中ビタミンB₁値2.9μg／dl，赤血球トランスケトラーゼ活性0.76IU／gHb,TPP効果11％．胸部X線像で心拡大と肺うっ血，心電図でT波の平低化，心エコーでは心嚢液貯留と左室壁肥厚および過動心状態を認め脚気心と診断．フルスルチアミン100mg静注15分後に，心拍出量は10.7より7.24 l／min，全末梢血管抵抗は352より848 dynes・sec・cm⁻⁵へといずれも劇的な改善を示した．かかる血行動態の変動は，同剤経口投与による臨床症状・検査所見の改善後にはもはや認められなかった．同剤静注による急性効果の検討は，本症診断上極めて重要と考えられた．本例は，北海道では近年唯一の脚気心例であり，日常診療上心不全や心拡大例をみる際に本症をも念頭におくことが重要と思われた．

A 33-year-old man was admitted to Kushiro CityGeneral Hospital on February 27, 1989, because of palpitation, shortness of breath and anasarca. Eight months previously he had noted the onset of pretibial edema, which had progressed to anasarca. He had had a meal only once a day for nine months.

Physical examination revealed a blood pressure of 114/46 mmHg and pulse rate of 80/min. The 3rd sound was audible. No rales in the chest and no hepatos-plenomegaly were noted. Ascites, pretibial edema and anasarca were present. Vibration sensation was dimini-shed, and the deep tendon reflexes were absent in the legs.