日本新生児成育医学会雑誌　第30巻　第2号　47～51頁（2018年）

日本新生児成育医学会雑誌　30(2)：295-299；2018　

受付日：平成29．09．14

受理日：平成30．02．01

硫酸アトロピン療法が効果を示さなかった，肥厚性幽門狭窄症の早産児例

A Preterm Infant with Hypertrophic Pyloric Stenosis Resistant to Atropine Therapy

＊1りんくう総合医療センター　小児科，＊2大阪母子医療センター　新生児科

＊1Pediatrics, Rinku General Medical Center，＊2Neonatology, Osaka Women’s and Children’s Hospital

寺村崇哉＊1・今西洋介＊2・山本昌周＊1・和田芳郎＊1・住田　裕＊1

Takaya TERAMURA＊1，Yosuke IMANISHI＊2，Masahiro YAMAMOTO＊1，Yoshiro WADA＊1，Yutaka SUMIDA＊1

Key Words：hypertrophic pyloric stenosis，low birth weight infant，preterm infant，atropine

　在胎34 週5 日，出生体重1,524g の男児。頭位経腟分娩にて出生し，呼吸障害はなかった。当院NICU に入院し輸液のみ行い，哺乳は早期に確立し日齢23 に2,100g となり退院した。退院後から嘔吐が出現し，日齢30 の外来受診時に1,936g と退院時から7.8％の体重減少を認めた。画像検査にて肥厚性幽門狭窄症（hypertrophic pyloric stenosis： HPS）と診断し入院とした。硫酸アトロピン（以下，硫アト）0.1mg/kg/ 日を1 日8 回に分割して静脈内へ緩徐に投与した。しかし治療効果に乏しく，0.11mg/kg/ 日に増量後，副反応の頻脈が出現したため手術に方針を変更した。入院9 日目にRamstedt 手術を施行し術後4 日で軽快退院となった。本邦の硫アト療法を施行した早産児HPS 報告例で，本例の治療前体重減少率は最も大きく，治療開始前の栄養状態が，硫アト療法の効果に影響した可能性が考えられた。

　A male infant was born at 34 weeks of gestation and was admitted to the neonatal intensive care unit（ NICU） at our hospital. Although the infant’s hospital stay was uneventful and the patient was discharged on day 23 with a body weight of 2,100g, projectile vomiting frequently occurred at home. On day 30, which was the patient’s first visited to our hospital for a medical checkup, the patient’s body weight was 1,936g, corresponding to 7.8％ of the body weight reduction rate. Ultrasonographic investigations revealed hypertrophic pyloric stenosis （HPS）. We started atropine therapy at 0.1mg/kg/day after hospitalization. However, the projectile vomiting did not resolve. The patient’s heart rate increased to 160 ～ 180 bpm when a higher dose of atropine was given. We considered this tachycardia an adverse effect of atropine therapy and therefore performed Ramstedt’s operation.
　In terms of HPS in preterm infants, all patients were diagnosed in the NICU. However, this patient developed HPS at home, which may have delayed the diagnosis and resulted in a 7.8％weight loss. The accompanying loss of body fluid may have provoked the tachycardia. In preterm infants, the suggestion is to initiate atropine therapy at the incipient stage of HPS, before the loss of weight significantly affects the body fluid status. To the best of our knowledge, this is the first report of a Japanese preterm infant with hypertrophic pyloric stenosis resistant to atropine therapy.