先天性α₂-plasmin inhibitor (α₂-PI)欠乏症患者(15歳,女性)の左大腿骨骨髄内血腫掻把術に対する麻酔管理を経験した.手術は気管内挿管による吸入麻酔(酸素,笑気,エンフルレン)下に行なわれ,術中の止血管理には抗線溶剤トラネキサム酸を用いた.術前,術中,術後を通じてトラネキサム酸の投与により,ユーグロブリン溶解時間,ウロキナーゼ添加フィブリン塊溶解時間,フィブリノゲン量,FDPは,全経過を通じて正常範囲内に維持され,異常出血は認められなかった.本症の術中止血管理にトラネキサム酸は有効,有用であった.本論文は先天性α₂-PI欠乏症の麻酔管理としては世界初の報告である.

抄録全体を表示

It is well known that the myoglobinuric acute renal failure caused by drugs is an important clinical aspect of nephrology. On the other hand, neuroleptic malignant syndrome is an uncommon, but potentially fatal, idiosyncratic reaction to neuroleptics and is characterized by muscular rigidity, fever, autonomic dysfunction and altered consciousness. The most common serious complication of malignant syndrome is rhabdomyolysis. We investigated 10 cases with acute renal failure induced by haloperidol and other neuroleptics. At the time they developed acute renal failure, the patients were taking a wide variety of medications. However, seven of the patients who developed acute renal failure, had received haloperidol, phenothiazine and anticholinaergic drugs, and 2 cases with acute renal failure were taking lithium. Characteristic clinical manifestations of malignant syndrome were observed in 7 patients who had been administered haloperidol orally or intravenously. All of the patients with acute renal failure induced by haloperidol, lithium and other neuroleptics were treated succsessfully with blood purification therapy (HD or HDF). We concluded that acute renal failure associated with malignant syndrome evoked by haloperidol is an indication for blood purification therapy.

抄録全体を表示