エンドトキシン吸着療法が奏効した急性腎盂腎炎に伴う敗血症性ショックの1例

Abstract

59歳男.発熱, 右背部痛を主訴とした.KUBで右尿管U1の部位に直径4×4mm右尿管結石が認められた.超音波検査で右腎はごく軽度に水腎症を呈していた.入院後敗血症ショックを呈し, 直ちに昇圧剤(Dopamine)の投与と抗生剤をIPM/CSに変更した.昇圧剤の増量を行ったが血圧は上昇せず, 血液検査では著明なleukocy tosisおよび敗血症に伴う凝固能の低下を認めた.敗血症性ショックの改善及びエンドトキシンの除去を目的にエンドトキシン吸着カラムを用いてエンドトキシン吸着療法を施行した.吸着開始後約1時間で次第に血圧の上昇を認め昇圧剤の減量が可能となった.再度吸着療法を施行し, 同日にショックから離脱した.自然排石が確認された.尚, 入院時血液及び尿培養からいずれも大腸菌が検出され, 敗血症の原因菌と同定した

Although septic shock has a high mortality rate of 43%, recently the endotoxin adsorption column was established and its efficacy is interesting. We report a very effective case of endotoxin adsorption the rapy for septic shock due to acute pyelonephritis. A 59-year-old man with chief complaints of pyrexia and right backache was referred to our hospital with a small right ureteral stone (4 mm) associated with a low degree of right hydronephrosis. Since it was diagnosed as right acute pyelonephritis, antibiotics were administered; and then septic shock occurred on the day of hospitalization. Endotoxin adsorption therapy was performed for two days and hemodynamic stability was achieved. The concentration of blood endotoxin was reduced remarkably and the efficacy of endotoxin adsorption therapy was suggested.