エンドトキシン吸着療法(PMX-DHP)にて救命した重症肺炎球菌性肺炎の2例

Severe Pneumococcal Pneumonia Successfully Treated with Direct Hemoperfusion using a Polymyxin B Immobilized Column:Two Case Reports

要旨　症例1：69歳男性．急速な呼吸不全の悪化，血圧の低下を認め，入院3時間後に気管内挿管を行った．翌日にはFiO₂ 0.85を要するまで酸素化が悪化したためエンドトキシン吸着療法(direct hemoperfusion using polymyxin B immobilized column;PMX-DHP)を2回施行した．施行中より血圧，酸素化の改善を認め，第5病日に抜管できた．症例2：47歳男性．意識障害，呼吸不全を認め，気管内挿管を行った．その後もショックの進行を認めたためPMX-DHPを2回施行した．施行中より血圧，酸素化の改善を認め，第6病日に抜管できた．両症例共に肺炎球菌性肺炎によるnear-fatalであったが，救命し得た．急速な進行を認める重症例ではPMX-DHPは選択肢の一つになりうると考えられた．

　The first patient was a 69-year-old man with fever and dyspnea. He was intubated 3 hours after admission, because of rapid deterioration of cardiorespiratory conditions. On the following day, he developed severe hypoxemia. Hence, we performed direct hemoperfusion using a polymyxin B immobilized column(PMX-DHP)twice. His blood pressure and oxygenation improved rapidly during PMX-DHP. He was extubated on the fifth day after admission. The second patient was a 47-year-old man with fever and dyspnea. He was intubated on admission because of drowsiness and hypoxemia. He developed hypotension, and therefore we performed PMX-DHP twice. His blood pressure and oxygenation improved rapidly during PMX-DHP. He was extubated on the sixth day after admission. In near-fatal cases of pneumococcal pneumonia, rapid deterioration of cardiorespiratory conditions is often observed. In such a critical case, PMX-DHP should be considered as one of the therapeutic approaches.