冠状動脈バイパス術後に著明な循環不全とともに高血糖・高乳酸血症を呈し治療に難渋した1例

Intractable Hyperglycemia and Hyperlactatemia with Severe Circulatory Failure after Coronary Artery Bypass Grafting；Report of a Case

はじめに　周術期管理において，血糖値および血中乳酸値のモニタリングは重要な指標である．われわれは，冠状動脈バイパス術（CABG）後に著明な循環不全とともに高血糖，高乳酸血症を呈し，治療に難渋した1例を経験したので報告する．

The patient a 75-year-old man who was treated for diabetes and angina pectoris. He relapsed with an angina attack. Coronary angiography revealed three-vessel disease. We performed coronary artery bypass grafting （CABG）. During surgery, we converted from off-pump CABG to on-pump beating CABG because of hemodynamic instability. After surgery, severe circulatory failure occurred with uncontrollable hyperglycemia and hyperlactatemia, which did not improve with catecholamine administration and insulin infusion. However, after continuous hemodiafiltration （CHDF） was initiated, in addition to aortic balloon pumping, his arterial blood pressure increased, and blood glucose and lactate levels decreased. Postoperative hyperinflammatory condition might have induced severe circulatory failure, hyperglycemia, and hyperlactatemia. CHDF might　have contributed to improving the condition.