著者
今泉 均 角田 一眞 渡辺 明彦 升田 好樹
出版者
THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA
雑誌
日本臨床麻酔学会誌 (ISSN:02854945)
巻号頁・発行日
vol.8, no.4, pp.343-347, 1988-07-15 (Released:2008-12-11)
参考文献数
12

虚血性心疾患の既往のない, 69歳男性の腹部大動脈瘤破裂の緊急手術前に, 中心静脈カテーテル挿入のため右内頸静脈穿刺時, 突然STの上昇と共に徐脈, 血圧低下を認めた. 腹部大動脈瘤患者では高率に冠動脈疾患を合併することから, 冠動脈硬化による冠動脈血管の tonus の亢進した状態下に, 中心静脈穿刺時の迷走神経刺激が誘因となって冠動脈スパズムが発生したものと考えられた.明らかな虚血性心疾患の既往がなくても全身的に高度な動脈硬化性疾患を有する患者の麻酔管理においては, 冠動脈硬化病変の存在並びに冠動脈血管の tonus の亢進によって, 冠スパズムや重症な不整脈の発生し易いことを十分に念頭におくべきである.
著者
石間 巧 南波 仁 清水 斎 角田 一真
出版者
Japanese Association for Acute Medicine
雑誌
日本救急医学会雑誌 (ISSN:0915924X)
巻号頁・発行日
vol.3, no.1, pp.12-15, 1992-02-15 (Released:2009-03-27)
参考文献数
17
被引用文献数
1

We report a case of rhabdomyolysis complicated by acute renal failure caused by loss of consciousness after drinking. A 46-year-old man fell asleep in his living room after drinking beer and whisky. Showing no signs of awakening by 10 a.m. the next morning, he was transferred to our emergency center. On admission his consciousness level was II-30 (Japan coma scale), and his temperature was 31.1°C. Laboratory data showed hypoglycemia; mixed acidosis; and elevation of CPK, GOT and LDH. The serum ethanol concentration was 221mg/dl. At the midnight on the first hospital day, swelling of the right hip area develope and it declined to be growing. The patient's consciousness gradually returned, however, he remained oliguric despite treatment with fluid challenge and diuretics. A diagnosis of rhabdomyolysis complicated by acute renal failure was made, and hemodialysis was performed. A triacetate membrane was selected as the dialyzer in order to eliminate serum myoglobin. The acute renal failure improved after hemodialysis 20 times in 38 days. The cause of the rhabdomyolysis is believed to have been pressure necrosis due to immobility for many hours in addition to muscle damage caused by ethanol. Hemodialysis with a triacetate membrane was useful in eliminating myoglobin in acute renal failure caused by rhabdomyolysis.