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Kokyu to Junkan Volume 55, Issue 10 （October 2007）

呼吸と循環 55巻10号（2007年10月発行）

Japanese English

症例

難治性敗血症性ショックに対しバソプレシン持続投与が劇的に有効であった1例 Successful Treatment of Refractory Septic Shock with Low Dose Vasopressin 平岡栄治 ¹ , 森寛行 ¹ , 宮原俊介 ¹ , 谷岡洋明 ¹ , 清水政克 ¹ , 宮本宣友 ¹ , 岩井愛雄 ¹ , 松田康章 ¹ , 金澤健司 ¹ , 橋本正良 ¹ , 秋田穂束 ¹ Eiji Hiraoka ¹ , Hiroyuki Mori ¹ , Shunsuke Miyahara ¹ , Hiroaki Tanioka ¹ , Masakatsu Shimizu ¹ , Yoshitomo Miyamoto ¹ , Chikao Iwai ¹ , Yasuaki Matsuda ¹ , Kenji Kanazawa ¹ , Masayoshi Hashimoto ¹ , Hozuka Akita ¹ ¹神戸大学医学部附属病院総合診療部 ¹Department of General Internal Medicine, Kobe University Hospital キーワード：バソプレシン , 難治性敗血症性ショック , vasopressin , refractory septic shock Keyword: バソプレシン , 難治性敗血症性ショック , vasopressin , refractory septic shock pp.1165-1168

発行日 2007年10月15日 Published Date 2007/10/15

DOI https://doi.org/10.11477/mf.1404100910

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要旨　患者は，粟粒結核による呼吸不全・敗血症性ショックにて入院した47歳の男性である．抗菌薬，急性呼吸窮迫症候群に対する低用量・低圧換気，大量輸液，ノルアドレナリン持続静注にて初期は血圧が維持できた．しかし，入院第2日にはノルアドレナリンの高用量持続投与(25μg/分)にもかかわらず血圧が50/20mmHgと難治性のショックに陥った．バソプレシンの少量持続投与(0.04U/分)を開始したところ，血圧が劇的に改善しノルアドレナリンの減量，中止に成功し救命できた．難治性敗血症性ショックに対するバソプレシン投与に関する文献的考察も含めて報告する．

A 47-year-old male was admitted to a certain hospital with enteritis of unknown etiology 3 months before the admission to our hospital. He was treated with pulsed steroid, followed by high dose prednisolone. He was discharged 2 days prior to our admission with high-grade fever and dyspnea. He came to our emergency room, where his blood pressure, pulse rate, body temperature and respiratory rate were 60/30mmHg, 100/min, 36.0℃, and 36/min, respectively. Chest X ray showed diffuse multiple small nodules. He was admitted to our hospital with the presumptive diagnosis of septic shock due to miliary tuberculosis, which was confirmed with sputum PCR of tuberculosis later. He was initiated on mechanical ventilation and was started empirically on anti-tuberculosis antibiotics, meropenem, and vancomycin immediately. Hydrocortisone was started for adrenal insufficiency secondary to chronic steroid treatment. For his septic shock, he was given normal saline bolus and norepinephrine infusion with central venous pressure and systemic blood pressure monitoring. On the second hospital day, his blood pressure was decreased to 50/20mmHg on norepinephrine 25μg/min. Then, we started continuous administration of vasopressin 0.04 units/minute for norepinephrine resistant septic shock. His BP went up to 100/50mmHg. His norepinephrine and vasopressin were successfully tapered off on the 4^th day and 5^th day, respectively. The mechanical ventilation was successfully weaned off on the 10^th day.

　Vasopressin level is elevated in the early phase of septic shock, but it is decreased to normal range with continued shock. This relative vasopressin deficiency has been reported to be one of the causes of refractory septic shock. Moreover, low dose of vasopressin has been demonstrated to be effective in raising the blood pressure. We reported a case of refractory septic shock which was successfully treated with low dose vasopressin. Low dose of vasopressin might be a useful salvage treatment for patients with refractory septic shock.