症例報告 頸髄損傷が誘因となった偶発性低体温症の1例  [in Japanese] A Case of Accidental Hypothermia Caused by Cervical Spinal Cord Injury  [in Japanese]

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Author(s)

    • 荒井 秀明 ARAI Hideaki
    • 産業医科大学病院救急・集中治療部 Division of Critical Care Medicine, Hospital of the University of Occupational and Environmental, Health, Japan.
    • 二瓶 俊一 NIHEI Shun-Ichi
    • 産業医科大学病院救急・集中治療部 Division of Critical Care Medicine, Hospital of the University of Occupational and Environmental, Health, Japan.
    • 宮岡 亮 [他] MIYAOKA Ryo
    • 産業医科大学脳神経外科学 Department of Neurosurgery, School of Medicine, University of Occupational and Environmental, Health, Japan.
    • 長田 圭司 NAGATA Keiji
    • 産業医科大学病院救急・集中治療部 Division of Critical Care Medicine, Hospital of the University of Occupational and Environmental, Health, Japan.
    • 新庄 貴文 SHINJO Takafumi
    • 産業医科大学病院救急・集中治療部 Division of Critical Care Medicine, Hospital of the University of Occupational and Environmental, Health, Japan.
    • 寺田 忠徳 TERADA Tadanori
    • 産業医科大学麻酔科学 Department of Anesthesia, School of Medicine, University of Occupational and Environmental, Health, Japan.
    • 後藤 慶 GOTO Kei
    • 産業医科大学病院救急・集中治療部 Division of Critical Care Medicine, Hospital of the University of Occupational and Environmental, Health, Japan.
    • 原山 信也 HARAYAMA Nobuya
    • 産業医科大学病院救急・集中治療部 Division of Critical Care Medicine, Hospital of the University of Occupational and Environmental, Health, Japan.
    • 相原 啓二 AIBARA Keiji
    • 産業医科大学病院救急・集中治療部 Division of Critical Care Medicine, Hospital of the University of Occupational and Environmental, Health, Japan.
    • 蒲池 正幸 KAMOCHI Masayuki
    • 産業医科大学病院救急・集中治療部 Division of Critical Care Medicine, Hospital of the University of Occupational and Environmental, Health, Japan.

Abstract

偶発性低体温症は,寒冷環境に暴露され深部体温が低下した状態であり,体温が低くなるほど死亡率が高いとされている.今回我々は,当初意識障害および高度低体温により救急搬送され,後に軽微な外力により頸髄損傷を合併していたことが判明した症例を経験したので報告する.症例は70歳代女性.意識障害および高度低体温により当院救急外来に搬送された.来院時直腸温26.2℃と高度低体温であったため,直ちに復温処置を行った.復温に伴い意識レベルは改善したが,C5領域以下の麻痺および感覚低下を認めたため,頸髄損傷を疑いMRIを施行.C5頸髄損傷と診断した.偶発性低体温症による意識障害のため,頸髄損傷の神経学的所見がマスクされていた可能性がある.偶発性低体温症の症例では誘因として,頸髄損傷の存在を念頭におき対応する必要がある.

Accidental hypothermia is the state in which body temperature falls due for exposure to a chilly environment. In accidental hypothermia, the mortality rate is higher the lower the body temperature. We report a case of a consciousness disorder and severe hypothermia, with a body temperature below 28℃, in which it later became clear that a cervical spinal cord injury had been caused by a small external force. A 70-year old woman was transported to our hospital in an ambulance for consciousness disturbance and severe hypothermia. At the time of arrival, her rectal temperature was 26.2℃. We promptly performed rewarming. Her consciousness level became clear, but paralysis and diminished sensation were observed below the C5 domain. We suspected cervical spinal cord injury and performed cervical magnetic resonance imaging. She was diagnosed as having C5 cervical spinal cord injury. When there is a consciousness disorder due to accidental hypothermia, it might not be possible to evaluate the neurological value of the cervical spinal cord injury correctly. The presence of cervical spinal cord injury should be considered when patients have a decreased consciousness level due to hypothermia.

Journal

  • Journal of UOEH

    Journal of UOEH 34(3), 259-264, 2012-09-01

    The UOEH Association of Health Sciences

Codes

  • NII Article ID (NAID)
    110009495738
  • NII NACSIS-CAT ID (NCID)
    AN0009832X
  • Text Lang
    JPN
  • ISSN
    0387-821X
  • NDL Article ID
    023974524
  • NDL Call No.
    Z19-1000
  • Data Source
    NDL  NII-ELS 
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