扁剔可否の簡易検査法の試み—扁桃マッサージと尿アセトンに関する臨床的研究

A NEW PRACTICAL TEST FOR PREVENTING ACCIDENTS IN TONSILLECTOMIES: A STUDY OF THE METHOD BY WHICH ACETONURINE MAY BE A SIMPLE MASSAGE OF THE TONSILS

　Ⅰ．緒言

　扁桃剔出後に起こる重篤な合併症の一つに自家中毒症があり，われわれもすでに報告^6）9）している。

　この面から，術後の患者の状態を観察してみると，昏睡状態におち入つた重症例のみならず，軽い腹痛，嘔吐程度の軽症と見過ごされてきた症例の中にも，いくつか当てはまる例があつたのではなかろうか？検査法の発達と相まつて，扁剔の適応の有無は昔より厳密になつたとはいえ，事故を未然に防ぎ得る確実な検査法はまだない。耳血，検尿などで異常がなくても，思わぬショック発作や，出血，合併症が起こり得る現在では，いつも不安の連続である。われわれは，重篤な術後性自家中毒症例に遭遇するまでは，術前検査は耳血一式の他，検尿も，蛋白，糖，ウロビリノーゲン，沈渣しか調べていなかつた。しかし，手ひどい目にあつて以来，全例に必ず，術前の尿アセトンの有無を調べている（後述）。

　At times the syndrome of acetonemic vomiting may be encountered after a tonsillectomy in children. On the other hand, more or less acetonurine may found after tonsillectomy even when there be no sign of acetonemic vomiting.

　In this study the authors made a special consideration of these two factors in carrying out surgical procedures to prevent unfavorable hazards such as primary shock or autointoxication symptoms during or after the operation. The testing method consists of a simple massage applied to the tonsils and the urine is tested for acetonurine 1 and 2 hours after such stimulation.

　In a number of clinical trials, acetonurine was found in a high incidence after a stimulation of the tonsils in this way. And in such cases the occurrence of primary shock symptoms during the operation or autointoxication after operation were also high in percentage. Particularly with children whose sympathic nervous system appeared unstable these symptoms appeared to be emphasized.