IABPによる循環補助が著効したカテコラミン抵抗性脚気衝心の1例

抄録

A 49-year-old woman with severe shock and metabolic acidosis was transferred to our hospital. She had no cardiac disease. The patient had been treated with salazopirine, steroid and parenteral hyperalimentation at a local hospital for ulcerative colitis for 3 years. One week ago, she experienced bilateral abductor paralysis. When the steroid dosage was decreased 2 days ago, she developed sudden shock and consciousness disturbance. Large-dose steroid therapy was administered, but her hemodynamic state failed to improve. On admission, her hemodynamics and metabolic acidosis deteriorated despite administration of large-dose catecholamines, sodium bicarbonate and fluid resuscitation. The patient showed characteristic clinical signs of shoshin beriberi, such as abductor paralysis, malnutrition and low output syndrome (LOS), and the cause of the shock was suspected to be shosin beriberi due to long-term parenteral hyperalimentation without vitamins. The patient was therefore put on assisted circulation by intra-aortic balloon pumping (IABP) and vitamin B₁ (thiamine) therapy. Immediately after starting IABP, her hemodynamics, metabolic state, oxygenation and level of consciousness improved dramatically. Six hours later, her hemodynamics had stabilized, and administration of adrenaline was discontinued. The next day, she was weaned from IABP, and five days later, the patient was discharged from the ICU without any complications. It is concluded that IABP is useful in patients with catecholamine-resistant LOS such as shoshin beriberi until efficiency of the fundamental therapy.