経皮的心肺補助（ＰＣＰＳ）にて救命しえた甲状腺中毒心の１症例

• Published in: 蘇生 Vol. 20; no. 1; pp. 44 - 48
• Main Authors: Utada Kohji, Matayoshi Yasutoshi, Kondoh Kaori, Tamura Hisashi, Nomura Shigeru, Koizumi Yumika, Nakamura Kumiko
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Reanimatology 2001; 日本蘇生学会
• Subjects: echocardiography; PCPS; thyrotoxic heart disease; 心エコー; 甲状腺機能亢進症
• ISSN: 0288-4348; 1884-748X
• DOI: 10.11414/jjreanimatology1983.20.44

A 65-year-old man admitted to our hospital because of atrial fibrillation with tachycardia. He had a one-year history of hyperthyroidism without any medications. The past history and the present symptoms (nausea, general-ized fatigue, weight loss) suggested thyrotoxic crisis to prompt antithyroid drug therapy combined with β-blockade. On the second hospital day, he developed dyspnea, confusion and hypotension. An echocardiographic study showed diffuse severe hypokinesis. The circulatory failure was rapidly progressive to cause profound shock refractory to inotropics and vasopressors. Percutaneous cardiopulmonary support (PCPS) was therefore initiated. The cardiac function was too seriously depressed to be estimated reliably by the echocardiography until the third hospital day. The echocardiographic studies showed improving cardiac function thereafter. The patient was readily weaned from PCPS because cardiac function was stable and improved with an estimated left ventricular ejection fraction (LVEF) of 30 percent on the eighth hospital day. Acute renal failure and hepatic insufficiency developed but resolved without blood purification. He was discharged from ICU on the 17 th hospital day. This case illustrates that the laboratory examinations showing low level of TSH and increased TSH receptor antibody strongly supported the diagnosis of thyrotoxicosis to account for severe depression of the systolic function, for which the echocardiography facilitated the early initiation and weaning of PCPS. 症例は65歳男性で, 嘔気・嘔吐, 全身倦怠感などを主訴として入院した。頻脈性心房細動を認め, 甲状腺クリーゼの疑いで, β遮断薬, 抗甲状腺薬が投与された。第2病日に呼吸困難, 意識障害が出現し, 心原性ショックへと移行した。心エコーで高度のびまん性壁運動低下が著明で進行性であったため, ただちに経皮的心肺補助 (PCPS) を開始した。第3病日までは壁運動がまったく認められなかったが, 第8病日に30%と改善し, PCPSから離脱した。DIC, 肝不全, 腎不全を合併したが, 血液浄化を行うことなく改善した。本症例は病歴, 臨床症状, 甲状腺機能検査より甲状腺中毒心と診断され, PCPSの導入・離脱の判断に心エコーは有用であった。