第1巻 2005年6月　第3号

■症例から学ぶ

感染源同定に苦慮した敗血症性ショックの1例―敗血症治療のガイドライン
白石　振一郎, 横田　裕行, 山本　保博
日本医科大学付属病院高度救命救急センター

A Case of Septic Shock of Unknown Origin Guidelines for Management of Sepsis
Shin-ichiro Shiraishi, Hiroyuki Yokota and Yasuhiro Yamamoto
Department of Emergency and Critical Care Medicine, Nippon Medical School

A 75-year-old man with histories of myocardial infarction, cerebellar infarction and benign prostatic hyperplasia was transferred to our critical care center because of progressive dyspnea and disturbance of consciousness. He was intubated for the treatment of hypoxemia under 10 L/min oxygen inhalation with a mask-reservoir bag device. He showed septic shock, and initially we treated him as a case of sepsis due to pneumonia, as indicated by a chest X-ray. But his condition worsened despite the treatment for severe sepsis, which was carried out in accordance with guidelines published in 2004¹. We performed a systemic examination by CT scan and found slight hydronephrosis due to incompletely incarcerated urolithiasis at the second hospital day. We diagnosed pyelonephritis, performed nephrostomy and drained pyuria. Subsequently he became hemodynamically stable and was transferred to another hospital for rehabilitation.

日医大医会誌 2005; 1(3), 135-139

Key words
severe sepsis, guideline, pyelonephritis

Correspondence to
Shin-ichiro Shiraishi, Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
E-mail：shinshi615@syd.odn.ne.jp

受付：2005年3月15日　受理：2005年4月27日