Toki Takayuki, Mizunoya Kazuyuki, Itabashi Misa, Nishikawa Naoki, Hoshino Koji, Saito Hitoshi, Morimoto Yuji
Department of Anesthesiology and Critical Care Medicine, Hokkaido University Hospital, N14W5, Kita-ku, Sapporo, 060-8648, Japan.
JA Clin Rep. 2025 Jan 27;11(1):5. doi: 10.1186/s40981-025-00765-0.
Plasma exchange (PE) removes high-molecular-weight substances and is sometimes used for antineutrophil cytoplasmic antibody-associated vasculitis (AAV) with alveolar hemorrhage. Hypotension during PE is rare, except in allergic cases. We report a case of shock likely caused by increased pulmonary vascular resistance (PVR) during PE.
A 66-year-old man with pulmonary hypertension (PH) and glomerulonephritis was admitted with dyspnea. He had discontinued sildenafil prior to admission. Alveolar hemorrhage associated with AAV was suspected, and PE was performed. Soon after, he developed circulatory failure and hyperlactatemia. Echocardiography revealed right ventricular dilation, suggesting increased PVR. Inhaled nitric oxide (iNO) was administered, rapidly improving hyperlactatemia and oxygenation. The shock observed during PE was attributed to multiple factors, including the potential removal of sildenafil, which may have led to an increase in PVR.
The shock was attributable to acute right heart failure caused by an exacerbation of PH, possibly due to sildenafil removal via PE, although other contributing factors could not be excluded.
血浆置换（PE）可清除高分子量物质，有时用于治疗伴有肺泡出血的抗中性粒细胞胞浆抗体相关性血管炎（AAV）。除过敏情况外，PE期间发生低血压较为罕见。我们报告一例在PE期间可能因肺血管阻力（PVR）增加而导致休克的病例。
一名66岁患有肺动脉高压（PH）和肾小球肾炎的男性因呼吸困难入院。入院前他已停用西地那非。怀疑与AAV相关的肺泡出血，遂进行了PE。不久后，他出现循环衰竭和高乳酸血症。超声心动图显示右心室扩张，提示PVR增加。给予吸入一氧化氮（iNO）治疗后，高乳酸血症和氧合迅速改善。PE期间观察到的休克归因于多种因素，包括可能清除了西地那非，这可能导致PVR增加。
休克归因于PH加重引起的急性右心衰竭，可能是由于通过PE清除西地那非所致，尽管不能排除其他促成因素。
