中枢性尿崩症患者の開心術周術期に体液管理に難渋した1症例

Difficult Fluid Management during the Perioperative Period of Open-heart Surgery in a Patient with Central Diabetes Insipidus

要旨

　中枢性尿崩症患者に対する開心術周術期管理を経験した。術中からバソプレシン持続静注を行い，術後にデスモプレシン経口投与に切り替えたところ，尿量が増加し体液管理に難渋した。バソプレシン持続静注を再開し，より厳格に体液量と電解質を評価して，デスモプレシン経鼻投与を経て経口投与へ変更することで管理できた。

　There are only a few published reports regarding the perioperative management of open-heart surgery in patients with central diabetes insipidus. We present the case of a 35-year-old man with central diabetes insipidus who underwent a second open heart surgery conducted to correct prosthetic valve insufficiency. Difficulties with the patient’s postoperative fluid management were encountered, but we were able to accomplish sufficient management by strictly evaluating the patient’s fluid volume and electrolytes and by switching from the continuous intravenous vasopressin to an intranasal and then an oral administration of desmopressin.