尿管結石を契機に発症したUrosepsisによる敗血症性ショック症例の検討

Abstract

対象は, 尿管結石を契機にurosepsisと診断され, 敗血症性ショックに進行した6例(全例女性, 平均年齢63.8歳)であった.全例血中および尿中から同一の菌が検出され, E.coli 4例, K.pneumoniae 1例, P.mirabilis 1例であった.治療は昇圧剤, 輸液, 抗菌剤投与を行い, 尿路管理では経皮的腎瘻造設4例(うち2例は自然排石), 尿管ステント挿入1例で, 自然排石の2例を除く全例に全身状態改善後ESWを施行した.全身状態の推移は発熱, 側腹部痛発症からショック状態までは2時間から4日間で, その後の集学的治療により8～32時間後にはショック状態から回復し, 発症から3～10日後に解熱, 炎症所見も改善した.エンドトキシン吸着療法を行った3例では, 行わなかった3例に比しショックからの回復や平熱化までの平均時間が短かった.以上のことからも, 速やかな全身管理を主とした集学的治療が予後を高めると示唆された

While a ureteral stone is a common disease, it occasionally causes urosepsis and septic shock. We analyzed 6 cases of septic shock due to urosepsis caused by a ureteral stone from August 1998 to September 2001. All patients were female, ranging in age from 38-76 years old (63.8 +/- 15.3). Stones ranged from 4 to 12 ml in size. The results of analysis of bacterial culture from blood and urine revealed E. coli in 4 cases, K. pneumoniae in 1 case and P. mirabilis in 1 case. Treatment, including intravenous transfusion, the administration of vasopressor drugs and antibiotics, and anti-disseminated intravascular coagulation (DIC) treatments were performed. Percutaneous nephrostomy in 4 cases and ureteral stent indwelling in 1 case were also used for the management of urinary tract. Extracorporeal shock wave lithotripsy (ESWL) was performed in 4 patients after improvement of general condition. Furthermore, the 3 most recent patients had also received therapy to remove endotoxins. All patients were diagnosed in a stone-free condition after a combination of these therapies. The mean recovery interval from shock condition to shock-free status seemed to be shorter in the patients that received the endotoxin removal therapy.