子宮外妊娠破裂による心肺停止の蘇生後に生じた相対的副腎機能不全に対してヒドロコルチゾン補充療法が有効であった1例  [in Japanese] Hydrocortisone-replacement therapy in a patient with relative adrenal insufficiency associated with cardiopulmonary arrest resulting from a ruptured ectopic pregnancy  [in Japanese]

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Abstract

子宮外妊娠破裂に伴う心肺停止の蘇生後に相対的副腎機能不全を発症した1例を経験した。症例は33歳,女性。子宮外妊娠破裂の発症から14時間後に当院に搬送され,直後に心肺停止となった。蘇生により心拍再開し,手術を行った。術後第1病日に循環動態が不安定になり,肺動脈カテーテルにて血管拡張性ショックと判明した。第2病日に相対的副腎機能不全を疑いACTH負荷試験後にヒドロコルチゾン200 mg・day<SUP>-1</SUP>の投与を開始し,循環動態は安定した。ヒドロコルチゾンを漸減しながら16日間投与した。負荷試験の結果は相対的副腎機能不全と一致した。また凝固障害,disseminated intravascular coagulation(DIC),急性肝不全・腎不全,多発脳出血などの多臓器不全に対して持続血液濾過透析,血漿交換などの治療を行い,状態が安定したので第24病日に一般病棟へ退室した。軽度の知能低下以外に障害を生じず社会復帰した。過大侵襲後の急性循環不全では,原因として相対的副腎機能不全も鑑別に入れて早期診断・治療を行うべきである。

We report a case of relative adrenal insufficiency associated with cardiopulmonary arrest resulting from a ruptured ectopic pregnancy. A 33-year-old female was transported to our hospital 14 hours after the rupture of an ectopic pregnancy; upon arrival, she immediately experienced cardiopulmonary arrest. Her heart was restarted using cardiopulmonary resuscitation (CPR), and she underwent an urgent operation. Her circulatory dynamics destabilized on the 1st postoperative day. An investigation using a pulmonary artery catheter revealed the cause of the instability to be vasodilatory shock. Hydrocortisone was administered after examination using adrenocorticotropic hormone (ACTH) loading. The initial dose of hydrocortisone was 200 mg·day<SUP>-1</SUP>; this dose was gradually tapered over a period of 16 days, and the patient's circulatory dynamics were stabilized. The results of the ACTH load examination suggested relative adrenal insufficiency. Continuous hemodiafiltration (CHDF) and plasma exchange, etc., were used to treat the patient's multiple organ failure, including the coagulation disorder, disseminated intravascular coagulation (DIC), acute liver failure, acute renal failure, and multiple brain hemorrhages. The patient's condition stabilized, and she was moved to a general ward on the 24th postoperative day. No permanent disabilities other than a slight decrease in intelligence were noted. Relative adrenal insufficiency should be considered as a possible cause of acute circulatory dysfunction resulting from extensive internal injury.

Journal

  • Journal of the Japanese Society of Intensive Care Medicine

    Journal of the Japanese Society of Intensive Care Medicine 15(1), 63-66, 2008

    The Japanese Society of Intensive Care Medicine

Codes

  • NII Article ID (NAID)
    130004514136
  • Text Lang
    JPN
  • ISSN
    1340-7988
  • Data Source
    J-STAGE 
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