トロンボモデュリン製剤を中心とした集学的治療が著効したf-TUL後の敗血症性ショックの1例

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タイトル別名
  • Septic Shock Following Flexible Transurethral Lithotripsy Showing Favourable Response after Multidisciplinary Treatment Mainly Composed of Recombinant Thrombomodulin : A Case Report
  • トロンボモデュリン セイザイ オ チュウシン ト シタ シュウガクテキ チリョウ ガ チョコウシタ f-TUL ゴ ノ ハイケツショウセイ ショック ノ 1レイ

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抄録

We herein present a case of a 65-year-old woman who developed severe septic shock following flexible transurethral lithotripsy (f-TUL) showing favourable response after treatment with doripenem and recombinant thrombomodulin (rTM). The patient underwent f-TUL for nephrolithiasis of the left kidney. Preoperative urine culture indicated the presence of a mucoid strain of E. coli that was susceptible to cefazolin ; therefore, the antibiotic cefazolin was administered as a preventive measure. The operation was completed without any specific intraoperative complications. On the day following the operation, blood pressure decreased and clouding of consciousness was observed. Hematological examination showed high levels of procalcitonin, a decrease in platelet count, and high levels of fibrin degradation products (FDP), indicative of severe septic shock and disseminated intravascular coagulation (DIC). The patient was immediately shifted to the intensive care unit (ICU), and multidisciplinary treatment consisting of doripenem (3 g/day) and rTM (380 U/kg) was administered. The medical treatment was successful ; the patient recovered from DIC at an early stage and was able to leave the hospital within 10 days after the operation. The risk of complications is expected to increase with the spread of f-TUL, and prompt action must be taken.

収録刊行物

  • 泌尿器科紀要

    泌尿器科紀要 58 (9), 499-502, 2012-09

    泌尿器科紀要刊行会

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