集中治療で救命し得た急性妊娠脂肪肝の1症例 A case of acute fatty liver of pregnancy treated with life-saving intensive care

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著者

    • 玉川 隆生 TAMAGAWA Takao
    • 埼玉医科大学総合医療センター産科麻酔科 Division of Obstetric Anesthesia, Saitama Medical Center, Saitama Medical University
    • 齋藤 利恵 SAITO Rie
    • 埼玉医科大学総合医療センター麻酔科 Department of Anesthesiology, Saitama Medical Center, Saitama Medical University
    • 福山 達也 FUKUYAMA Tatsuya
    • 埼玉医科大学総合医療センター麻酔科 Department of Anesthesiology, Saitama Medical Center, Saitama Medical University
    • 田村 和美 TAMURA Kazumi
    • 埼玉医科大学総合医療センター産科麻酔科 Division of Obstetric Anesthesia, Saitama Medical Center, Saitama Medical University
    • 照井 克生 TERUI Katsuki
    • 埼玉医科大学総合医療センター産科麻酔科 Division of Obstetric Anesthesia, Saitama Medical Center, Saitama Medical University
    • 小山 薫 KOYAMA Kaoru
    • 埼玉医科大学総合医療センター麻酔科 Department of Anesthesiology, Saitama Medical Center, Saitama Medical University
    • 宮尾 秀樹 MIYAO Hideki
    • 埼玉医科大学総合医療センター麻酔科 Department of Anesthesiology, Saitama Medical Center, Saitama Medical University

抄録

急性妊娠脂肪肝(acute fatty liver of pregnancy, AFLP)は妊娠後期に好発し,肝不全や腎不全を併発する母児共に死亡率の高い疾患である。症例は,43歳,女性。2経妊,1経産。妊娠36週時に,黄疸,嘔吐,乏尿を認め,近医より搬送された。入院時に肝不全,腎不全,disseminated intravascular coagulation(DIC)を認めたため,緊急帝王切開にて児を娩出した。術後母体はICUに入室し,入室1日目にAFLPの診断目的で肝生検を施行したが,生検後に大量出血を起こした。出血に対しては,肝動脈塞栓術,凝固因子製剤投与,大量輸血療法を施行した。腎不全に対しては持続血液濾過透析を施行し,母児ともに良好な転帰を得た。肝不全を合併しているAFLP症例では,凝固能の改善を待ってから肝生検を施行すべきである。

Acute fatty liver of pregnancy (AFLP) is a serious maternal illness caused by microvesicular fatty infiltration of hepatic and renal cells that can arise during the third trimester of pregnancy and result in significant perinatal and maternal mortality. We describe AFLP with hepatic and renal failure, multiple organ failure and disseminated intravascular coagulation (DIC) in a 43-year-old woman at 36 weeks of pregnancy. She was treated with respiratory and circulatory management in the ICU after Cesarean delivery. On postoperative day 1, she had perihepatic hematoma after liver biopsy for a diagnosis of AFLP and severe hemorrhage. She was transfused with a large volume of blood products and administered with blood coagulation factor (recombinant activated factor VII). She also underwent continuous hemodiafiltration and three transcatheter arterial embolizations. Her general status improved and she was discharged from the ICU on postoperative day 9. This experience indicated that in a patient with AFLP and hepatic failure, liver biopsy entails a risk of severe hemorrhage, and that liver biopsies for a diagnosis AFLP should be performed after recovering from coagulopathy.

収録刊行物

  • 日本集中治療医学会雑誌 = Journal of the Japanese Society of Intensive Care Medicine

    日本集中治療医学会雑誌 = Journal of the Japanese Society of Intensive Care Medicine 19(1), 71-74, 2012-01-01

    The Japanese Society of Intensive Care Medicine

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各種コード

  • NII論文ID(NAID)
    10030288245
  • NII書誌ID(NCID)
    AN10474053
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13407988
  • データ提供元
    CJP書誌  J-STAGE 
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