髋关节置换术后使用达比加群抗凝及对大面积肺栓塞进行溶栓治疗后发生急性肾上腺功能衰竭。
Acute adrenal failure following anticoagulation with dabigatran after hip replacement and thrombolysis for massive pulmonary embolism.
作者信息
Best Martin, Palmer Kate, Jones Quentin Christopher, Wathen Christopher G
机构信息
Department of Respiratory Medicine, High Wycombe Hospital, Buckinghamshire, UK.
出版信息
BMJ Case Rep. 2013 Jan 11;2013:bcr2012007334. doi: 10.1136/bcr-2012-007334.
Abstract
A 75-year-old woman presented 9 days post-total hip replacement with sudden onset of shortness of breath and fever. She had been discharged taking dabigatran. The patient was treated for sepsis with antibiotics and fluids. However, she deteriorated and was transferred to the intensive care unit. Following a 10 s asystolic episode the patient was thrombolysed with alteplase for presumed massive pulmonary embolism. Initially, her blood pressure and oxygen saturation improved. However, over the next few days, she remained persistently hypotensive. A CT scan of her chest, abdomen and pelvis demonstrated bilateral adrenal haemorrhages. A short synacthen test confirmed acute adrenal failure.
摘要
一名75岁女性在全髋关节置换术后9天出现突发气短和发热。她出院时正在服用达比加群。患者接受了抗生素和补液治疗脓毒症。然而，她的病情恶化，被转入重症监护病房。在一次10秒的心脏停搏发作后，患者因疑似大面积肺栓塞接受了阿替普酶溶栓治疗。最初，她的血压和血氧饱和度有所改善。然而，在接下来的几天里，她一直处于低血压状态。胸部、腹部和骨盆的CT扫描显示双侧肾上腺出血。短程促肾上腺皮质激素试验证实为急性肾上腺功能衰竭。
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