経尿道的前立腺切除術・膀胱結石破砕術後に敗血症性ショックを来しエンドトキシン吸着療法および持続的血液灌流濾過を施行した1例

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  • A case report of septic shock following transurethral resection of prostate and cystolitholapaxy successfully treated with PMX-DHP and CHDF

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<p> We present a case of 71-year-old man who developed severe septic shock following transurethral resection of prostate (TURP) and cystolitholapaxy (CLL), showing favorable response after multidisciplinary treatment consisting PMX-DHP and CHDF. The patient underwent TURP for prostatic hypertrophy and CLL for bladder stone. The operation was completed with no intraoperative complications. 3 days after operation, a 39.8°C fever, blood pressure decreased and clouding of the consciousness were observed. The patient was transferred to the intensive care unit (ICU) and treated with mechanical ventilation and appropriate drug therapy. 5 hours after admission to the ICU, first PMX-DHP treatment was performed for 16 hours, but hemodynamics was not improved and became no urination. Second PMX-DHP and CHDF treatment performed 9 hours after first PMX-DHP. After second PMX-DHP the patient got stable hemodynamics and sufficient urine volume. Mechanical ventilation was ended 9 days after the ICU admission and moved to the general ward.</p><p> Due to the impaired peripheral perfusion during hemodynamic crisis, all toes and 2 fingers were necrosis and amputated. After 6 months of rehabilitation, he discharged to home.</p>

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