Сase一例原位心脏移植术后肝肾功能衰竭的研究

IF 0.2 Q4 ANESTHESIOLOGY Anaesthesia, Pain & Intensive Care Pub Date : 2021-09-30 DOI:10.25284/2519-2078.3(96).2021.242151
A. Mazur, P. V. Gurin, R. Zatsarynnyy, O. Khomenko, V. Beleyovych, T. Domansky, N.YU. Ivanchenko
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引用次数: 0

摘要

介绍。心脏移植仍然是终末期心力衰竭(HF)的唯一根治方法。肝和/或肾功能障碍在心衰患者中很常见,人工循环和免疫抑制治疗也会加重,并导致术后并发症和死亡率。案例描述。患者P., 49岁,原位心脏移植后因多器官功能衰竭入住重症监护病房。怀疑移植排斥综合征,但经详细的临床和实验室检查及心肌活检后未确诊。患者因严重肾功能不全、肝功能不全,在ICU开始透析超滤,血流190 ml/min;超滤- 100 ml/h。该情况的发生是由于他克莫司的直接作用,因为患者在术后标准推荐剂量(每天0.2 mg / kg)后,该药物的血浆浓度极高(> 30 ng / ml)。根据文献,他克莫司的消除是由肝脏提供的,微粒体细胞色素P450 3A4。因此,患者极有可能是肝脏代谢衰竭。结论:由于他克莫司具有全身毒性,首次给药后监测其浓度至关重要。早期诊断代谢紊乱将防止他克莫司进一步的全身毒性。ICU的出液方法是他克莫司毒副作用中纠正肝肾功能不全的重要手段。
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СASE STUDY OF HEPATO-RENAL FAILURE IN A PATIENT AFTER ORTHOTOPIC HEART TRANSPLANTATION
Introduction. Heart transplantation remains the only radical treatment for end-stage heart failure (HF). Liver and / or renal dysfunction is common in patients with HF, which is also exacerbated by the use of artificial circulation and immunosuppressive therapy, and leads to postoperative complications and mortality. Case description. Patient P., 49 years old, after orthotopic heart transplantation was admitted to the intensive care unit (ICU) with signs of multiple organ failure. Graft rejection syndrome was suspected, but was not confirmed after the detailed clinical and laboratory examinations and according to the myocardial biopsy. Because of severe renal and hepatic insufficiency, patient at the ICU started to receive hemodiaultrafiltration with a flow of 190 ml/min; ultrafiltration – 100 ml/h. The condition, that developed was due to the direct effect of tacrolimus as the patient had a critically high plasma concentration of this drug (> 30 ng / ml) after the standard recommended postoperative dose (0.2 mg / kg per day). According to the literature, the elimination of the tacrolimus is provided by the liver, with microsomal cytochrome P450 3A4. Thus, the patient most likely had a failure of hepatic metabolism. Conclusion: Because of the systemic toxicity of tacrolimus, it is important to monitor its concentration after the first dose. Diagnosis of metabolic disorders at an early stage will prevent further systemic toxicity of tacrolimus. Efferent methods at ICU are the important tools for the correction of hepatic and renal insufficiency throughout toxic effects of tacrolimus.
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CiteScore
0.40
自引率
0.00%
发文量
56
审稿时长
4 weeks
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