外傷性解離性大腿動脈閉塞症にARDS,MNMSおよび敗血症を合併した1治験例

A Case of Traumatic Dissecting Femoral Artery Occlusion with ARDS, MNMS and Sepsis

　症例は26歳，男性，交通外傷による出血性ショックに大腿動脈解離性閉塞を合併，受傷約9時間後に血行再建を完了したが，第3病日にGOT 1,481U／ml,GPT 564U／ml，CPK 58,069U／mlとMNMSを合併した．第11病日にはPO₂25.7mmHgとARDSを合併，第19病日にはBUN 126.9mg／dl,Creatinine 4.8mg／dlと亜急性腎不全を併発し人工透析を開始した．また受傷直後より白血球増多（33,500／mm³），発熱を認め，Endotoxintestが217.8pg／mlと高値を示し敗血症も合併していた．重症合併症例にもかかわらず，救命できたのは，早期の高気圧酸素療法（OHP）とウロキナーゼおよびヘパリン投与により末梢循環が改善され，致命的高カリウム血症の出現を予防できたためと，ARDSに対して大量抗生剤併用によるステロイド投与とPEEPによる調節呼吸療法が奏効したためと考えられる．

A 26-yerar-old man, who had been injured seriously in a traffic accident, was admitted to our hospital. At that time his condition developed into shock caused by profuse bleeding, and his consciousness was marked by confusion with occasional tonic spasm.

At first we performed an operation for hemostatis on the left femoral vein under the region of the injury. Buthis left dorsal pedis artery was not palpable and arterial bleeding was increasing. Because of this a second operation was performed and an extra-anatomic by-pass with 6 mmΦ Gore-Tex graft for traumatic dissect-ing of the femoral artery, and a hemostatis on the left femoral artery were carried out. Three days after the injury, his condition showed complicated MNMS because serum CK rose until 58069 U/ml. Eleven days after injury, he was attacked of hypoxemia (P0₂ 25.7 mmHg) owing to ARDS. And 19 days after the injury, he came to need hemodialysis because of the increase ofBUN (127 mg/dl).

Steroid (methylprednisolone) and artificial respira-tion with PEEP were efficacious against ARDS. Hemodialysis was efficacious against renal insufficiency as a result of MNMS. And Vancomycin and Chloran-phenicol were useful for sepsis (maximum WBC: 33,500/mm³, Endotoxin test : 217.8 pg/ml) probably caused by Pseudomonas cepacia.