遅発性急性腎不全を発症した多発外傷の1例 A CASE REPORT OF LATE PRESENTATION OF ACUTE RENAL FAILURE AFTER TRAUMATIC MULTI-ORGAN INJURY ASSOCIATED WITH DIC

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症例は82歳,男性.交通外傷による多発性肋骨骨折,骨盤骨折,膵損傷の診断にて近医にて加療された.受傷翌日にDICを発症したが,蛋白分解酵素阻害剤にて,第7病日には回復した.第14病日には経口摂取が開始されたが,誤嚥により肺炎を併発し,再び全身状態が悪化した.第22病日には経口摂取不能,第23病日には乏尿状態となり,第25病日に当科へ転送された.水分負荷,利尿剤,カテコラミン投与を行ったが反応尿は得られず,肺水腫も合併したため血液透析を必要とした.以後透析を週3回施行し,第68病日に透析から離脱することが出来た.本症例は,外傷後のDICから回復後約2週間を経て急性腎不全をきたしたものである.その原因として,多発外傷による侵襲が加わった後,更に,蛋白異化充進状態の遷延,誤嚥性肺炎,水分投与量の相対的不足などの侵襲が加わり,腎機能障害が遅発性に顕在化した可能性が考えられた.

An 82-year-old man met a traffic accident, and was diagnosed as having multiple costal and pelvic fractures and pancreas injury with shock at another hospital. The patient got over the acute phase with conservative treatments. Disseminated intravascular coagulation (DIC) developed on day 2, which was medically treated with a successful outcome, and the patient so recovered that could have per os. Unfortunately, however, aspiration pneumonia develolped after misswallowing, and his general condition was gradually worsened, resulting in oliguria on day 25, when the patient was transferred to our department. No response to a water challenge test with diuretics and catecholamines was observed, and hemodialysis (HD) was commenced, from which the patinet could be weaned on day 68. The mechanism of the late presentation of acute renal failure (ARF) as 2 weeks after the recovery from DIC was considered as follows: The first attack by multi-organ injury, shock, and DIC could be scarcely endured, but the second attack by prolonged catabolic state with pneumonia and water imbalance might clinically manifest acute renal failure in a multiplicative way. It is stressed upon that a meticulous care should be continued after the recovery from the acute phase for aged patients, whose functions of many organs can be latently depressed.

収録刊行物

  • 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society

    日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 58(5), 1099-1103, 1997-05-25

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10008527600
  • NII書誌ID(NCID)
    AN00198696
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    03869776
  • データ提供元
    CJP書誌  J-STAGE 
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