重症熱傷死の剖検例

AUTOPSIED CASE OF SEVERE BURN

I．はじめに

　近年の物質文明の進歩発展と共に，大は戦争，交通災害，産業災害，小は一般家庭生活において軽症から重症にいたるさまざまの程度の熱傷の発生をみている。一方近代医学の進歩と共に，熱傷に対してもその救急処置，治療，後遺症対策などの面において，大きな進歩がみられ，受傷直後から専門家の治療をうければ，かなり広範囲の患者であつても救命しうるし，またその後遺症も軽減される。こうした熱傷医学を世界的なものにするために，1960年に第1回国際熱傷会議がワシントンで開催されている。

　熱傷患者における病態生理は，熱傷という局部の侵襲と，それに対する全身反応の総合^1）であり，これに対する正しい理解がなければ救命しうる患者も救いえないといえよう。われわれはこのたび受傷面積92％におよぶ広汎な重症熱傷例を経験，死後解剖したので，その臨床経過と剖検所見および組織所見を報告しあわせて若干の考察を加えたい。

An autopsied case of severe burn was reported. A 29-year-old man had had burn of grade 3 involving 92% of the body surface and was admitted in the hospital 14 hours after burning. Fluid supply by Brooke's method was started and necrectomy on the neck, chest and abdomen was performed. On the first day in hospital Ht value fell from 75% to 61%, and urine was 6ml. On the 2nd day Ht was 50%, and urine was 130ml. On the 3rd day Ht was 45% and urine was 70ml. On the 4th day urine was 4ml, and liver function was within normal limit.Serum ureanitrogen and creatinine level was 10 times higher than normal.

Staphylococcus aureus on the 3rd day and pseudomonas aeruginosa on the 4th day were cultivated from the lesion.

On the 4th day, 96 hours after burning, the patient succumbed. Main findings of autopsy were noted in the kidney. Swelling and regressive degeneration of tubules of the entire renal cortex were noted, but obstruction of tubules by hemoglobin cast, peritubular cell infiltration and phlebothrombosis were not proved. The picture was not compatible with lower nephon nephrosis. There was no gastric ulcer, but were a few bleeding spots on the mucosa of the stomack.

The man died in the toxic stage following after the first and second shock stages.