尿路閉塞による敗血症性ショックにエンドトキシン吸着療法を行った2症例

Abstract

症例1(74歳男).発熱, 全身倦怠を主訴とした.膀胱全摘, 左水腎症の既往を有し, 尿路感染にて抗生剤投与を受けたが改善はみられず, 左尿管回腸吻合部狭窄による左水腎症・水尿管から生じた膿腎症に敗血症性ショック・DICを合併したと診断した.症例2(74歳女).腹痛を主訴とした.未治療の糖尿病があり, 腹痛, 経口摂取不能, 体動困難にて入院し, 後腹膜線維化症から生じた右水腎症, 膿腎症に敗血症性ショック・DICを合併したと診断した.2例には腎瘻を造設して膿汁を排泄し, 補液, 昇圧剤を投与したが全身状態が悪化したため, polymixin B immobilized fiber columnを用いたエンドトキシン吸着療法を行い, 症例1には持続血液透析を併用した.その結果, 2例とも血圧の回復と良好な利尿が得られ, 抗生剤およびFOY, ATIII製剤, ヘパリンの投与と血小板輸血にて全身状態は改善した.なお, 症例2の血液培養と症例1, 2の尿培養からE.coliが検出された

Clinical experiences of endotoxin removal using polymyxin B immobilized fiber column (PMX) in two septic shock patients are reported. Case 1: A 74-year-old man with bladder cancer received a total cystectomy and a ileal conduit 19 years before he was referred to our hospital with complaints of high fever and general fatigue. Physical examination and laboratory data revealed severe hypotension, and pyuria. Left hydronephrosis due to uretero-intestinal stenosis were observed on computed tompgraphy (CT). Under the diagnosis of septic shock, left nephrostomy were performed. Direct hemoperfusion using polymyxin B immobilized fiber column was carried out. Case 2: A 74-year-old woman referred to our hospital with complaints of abdominal pain. Physical examination and laboratory data revealed severe hypotension, and pyuria. Right hydronephrosis due to retroperitoneal fibrosis were observed on CT. Diagnoses of septic shock were made. After right nephrostomy were performed, direct hemoperfusion using polymyxinB immobilized fiber column was carried out.