老人外科における副腎皮質機能に関する研究
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概要
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More recently surgical patients in the elderly has been increasing in number because of the prolongation of the average span of a man's life. Surgical importance in geriatrics needs no emphasis. There are numerous problems to be solved in this field. The author studied adrenocortical response against surgical intervention due to increasing surgical cases in the elderly and in the purpose of preventing postoperative complications.<BR>Sixty one patients over 60 years old and 20 patients between the ages of 21 and 57 years were involved in this study. Preoperatively the urine 17-OHCS and the blood level of 17.OHCS were determined and Thorn's test was performed by administering 20 units of ACTH-Z. Postoperatively the urine 17-OHCS was measuaed everyday.<BR>The results wereoas follows :<BR>I. Preoperatively both the urinary excretion rate of 17-OHCS and the reduction rate of eosinophiles were much remarkable in the younger than in the elder patients. There was a tendency to the adrenocortical hypof unction with age.<BR>2. In the elder patients no different adrenocortical response was observed between benign and malignant diseases, however the reduction of the urine 17-OHCS was noticed in the malignant disease in the younger patients.<BR>3. Preoperatively the maximum rate of 17-OHCS appeared 8 hours later in the urine and 4 hours later in the blood after administering ACTH. Postoperatively the maximum rate of of 17-OHCS appeared 24 hours later in the blood and 48 hours later in the urine. It was cleared that there was some excretive delay of the urine 17-OHCS compare with the blood level of 17-OHCS.<BR>4. On the rate of the urine 17-OHCS before and after operation there was remarkable difference between younger and elder patients, but on the rate of the blood level of 17-OHCS, there was no difference between them.<BR>5. Judging from the results of the urine 17-OHCS (pre-and postoperatively), surgical intervention even in both younger and elder patients by gastrectomy was relatively greater than preoperative administration of 20 units of ACTH on the influence to the body.<BR>6. There was no difference in the elderly about the preoperative urine 17-OHCS between gastric resection for gastric ulcer and radical operation for gastric cancer. Postoperatively large amount of the urine 17-OHCS was admitted in cases of the radical operation for gastric cancer. These suggest that adrenocortical response would depend on the kinds of the surgical intervention.<BR>7. On the relationships between preoperative adrenocortical response and postoperative pulmonary complications, there was some tendency to the poor preoperative response of the adrenal cortex in cases of the pulmonary complications. So there are possibilities of the pulmonary complications in cases of the poor preoperative response of the adrenal cortex.
- 学校法人 昭和大学・昭和医学会の論文