アブストラクト（44巻1号：神奈川歯学）

神奈川歯学

Japanese

Title　： 舌喉頭矯正術による乳児の核心・表面体温変化の解析
Subtitle　： 原著
Authors　： 北川有華, 山本伊佐夫, 中川貴美子, 大平寛, 向井將*
Authors（kana）　：
Organization　： 神奈川歯科大学社会歯科学講座法医学分野, *医療法人社団華青会向井診療所
Journal　： 神奈川歯学
Volume　： 44
Number　： 1
Page　： 36-47
Year/Month　： 2009 / 6
Article　： 原著
Publisher　： 神奈川歯科大学学会
Abstract　： 「緒言」 ヒトの体温は熱放散と熱産生のバランスによって36～37℃の範囲で保たれている. 子どもは身体活動や成長・発育のために大人に比べ活発な代謝活動のため, 基礎代謝量は高く, 体温も0.2～0.5℃ほど高い. しかし近年, 学校保健領域において小児の体温の標準値(平均値)が低下傾向にあることが問題となり, 体温が36.0℃未満の子供を「低体温児」と定義し定着されつつある1,2). 舌喉頭偏位症(ADEL)とは, 舌小帯の有無にかかわらず舌および喉頭の前上方への偏位により上気道の抵抗が増し呼吸が抑制される状態をいう. 舌喉頭矯正術(CGL)は, 舌小帯およびオトガイ舌筋の前束の一部を切断し舌・喉頭蓋ならびに喉頭が後下方へ移動し, 喉頭蓋ならびに喉頭の偏位を矯正する. このため, 口腔ならびに下咽頭腔は拡張し気管喉頭の開口方向は鼻腔と一直線となり上気道の抵抗を減少させることができ, 乳児では, チアノーゼ, 睡眠時無呼吸, 哺乳障害, 身体が硬い, 手足が冷たいなどの多様な症状が術直後から劇的に解消される3～5).
Practice　： 歯科学
Keywords　： 舌喉頭矯正術, 低体温, 核心体温, 表面体温

English

Title　： Analysis of changes in core and surface body temperature in infants after correction of the glosso-larynx
Subtitle　：
Authors　： Yuka KITAGAWA, Isao YAMAMOTO, Kimiko NAKAGAWA, Hiroshi OHIRA, Susumu MUKAI*
Authors（kana）　：
Organization　： Division of Forensic Medicine, Department of Dental Sociology, Kanagawa Dental College, *Otorhinolaryngological Division of Mukai Clinic
Journal　： Kanagawa Shigaku
Volume　： 44
Number　： 1
Page　： 36-47
Year/Month　： 2009 / 6
Article　： Original article
Publisher　： Kanagawa Odontological Society
Abstract　： [Abstract] One health problem in Japanese schoolchildren that has recently been receiving attention is an increase in the incidence of hypothermia, or a body temperature of under 36℃. Hypothermia can have undesirable effects on the body, such as poor blood circulation, decreased immunity, and metabolic disorders. Ankyloglossia with deviation of the epiglottis and larynx (ADEL) can inhibit respiration and increase upper airway resistance. ADEL can produce multiple symptoms such as infant cyanosis, sleep apnea, difficult in falling asleep, abdominal swelling, or coldness of the extremities. Correction of the glosso-larynx (CGL) is one therapy for ADEL. This involves cutting the frontal bundles of the genioglossus muscle, which allows the tongue to orient backwards and downwards and the larynx to be oriented straight relative to the epipharynx. As a result, vital capacity and forced expiratory volume in one second are increased, and the symptoms described above can be dramatically resolved. We have previously reported a relationship between ADEL and SIDS and child abuse. Almost all mothers of infants with ADEL have reported that their babies show coldness of the extremities, and that this shows marked improvement soon after CGL. We therefore investigated changes in the core and surface temperatures of infants that received CGL, and on the basis of the results, considered the physiological effects of CGL. Sixty infants ranging in age from one to four months were investigated. All underwent CGL surgery at the Mukai Clinic. The core temperature was measured using a tympanum thermometer. The surface temperatures on the forehead, hand and foot were measured using an infrared thermometer. In addition, SpO2 and pulse rate were measured in fourteen infants. The infants' mothers were asked about coldness of their babies' extremities before and one month after CGL. The infants were divided in two groups: those with a tympanic temperature indicating hypothermia of less than 36℃, and a normothermia group. Eleven infants had hypothermia. Their temperature began to increase one hour after CGL, and all had a significantly higher body temperature one month after the procedure. Forehead temperature in infants with an initial temperature of 34℃ rose after CGL. A similar improvement soon after CGL was also observed in infants with hand hypothermia of 33℃ and foot hypothermia of 31℃. Significant differences between the pre- and post-CGL temperatures were observed after one month in the infants with various types of hypothermia. Negative correlations were observed between the rates of change in core and surface temperatures before and after CGL. In particular, the rates of increase were higher in infants with lower surface temperatures of the hand and foot. A significant negative relationship between pulse rate and temperature of the hand and foot before CGL suggested that the hypothermia was sympathetic-dominant. The negative relationship between the rate of change in temperature and pulse rate suggested a switch from sympathetic-dominant to parasympathetic-dominant after CGL. A questionnaire survey revealed that although 93.3% of the mothers felt that their babies' extremities were cold before the operation, 89.3% considered that the extremities were warmer after CGL. The remarkable increase of temperature in the hypothermic infants suggested that both expansion of blood vessels and an increase in blood supply were attained as a result of respiratory improvement after CGL, which depressed sympathetic function. The core temperature remained higher one month after CGL, and therefore the setpoint temperature was considered to have increased. The improvement of infant hypothermia after CGL suggested that the hypothermia might be due to ADEL. Wider use of CGL will lead to improvements in immunity, and lowering of parental concern about childcare and fostering stress.
Practice　： Dentistry
Keywords　：