救命しえた劇症型A群溶連菌感染症の小児の1症例 A pediatric case of toxic shock like syndrome

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5歳, 男児が腹痛を主訴に来院した。胆汁性嘔吐とチアノーゼが続き, ショック状態から心肺停止に陥ったが蘇生に成功した。心拍再開後, 原因検索のため開腹術を施行したが, 腹腔内は副腎に少量の出血を認める以外は異常がなかった。手術終了後も意識は回復せず, 人工呼吸管理とカテコラミンによる循環管理を行った。肝機能および腎機能は低下し, 播種性血管内凝固 (DIC) の所見を示した。入院時の血液検体からA群溶連菌を認めたので, 抗生物質をアンピシリンに変更した。第3病日には意識の回復を認め, 全身状態も改善した。小児が腹痛で来院した場合は劇症型A群溶連菌感染症も念頭に入れて大腿部, 腰部の筋痛や軟部組織の異常にも注意すべきと思われる。

A 5-year-old male was admitted to our hospital complaining of abdominal pain. He became hypotensive and lost his consciousness after admission. Cardiopulmonary arrest occurred when endtracheal intubation was attempted, but immediate cardiopulmonary resuscitation restored spontaneous circulation. Three hours after resuscitation, the vital signs were stable and laparotomy was performed. No apparent abnormality was observed. After the operation, profound hypotension associated with loss of consciousness and disseminated intravascular coagulation necessitated the intensive therapy with catecholamine infusion and mechanical ventilation. While continuing intensive therapy, group A streptococcal organisms had been isolated from the blood sample taken at admission. Ampicilline 1 g was administered intravenously every 12 hour. The general condition gradually improved over the next 2 days and the patient regained consciousness. The patient was discharged without any clinical sequellae following a 12week hospitalization.

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  • 蘇生

    蘇生 20(2), 173-175, 2001-07-20

    The Japanese Society of Reanimatology

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