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连续脏置换疗法后的后面缺血视神经病变:一个病例报告
Hiro Takefuji1, Junpei Komagamine2
1Department of Emergency and Critical Care Medicine, NHO Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro, Tokyo, Tokyo, Japan. hrsdcc117@gmail.com.
International journal of emergency medicine
|March 29, 2025
概括
后性缺血视神经病变 (PION) 是连续置换疗法 (CRRT) 的罕见并发症. 这一案例突出了PION作为急性视力丧失的潜在原因,在患有血管风险因素的重症患者中.
科学领域:
- 眼科医生 眼科 眼科
- 腎臟病學 (nephrology) 是一種醫學專業.
- 密集护理医学 密集护理医学
背景情况:
- 后面缺血视神经病变 (PION) 是重症监护室 (ICU) 患者急性视力丧失的一个不常见的原因.
- 连续脏替代疗法 (CRRT) 后的PION以前没有报告过.
- 本报告详细介绍了在启动CRRT后双边非动脉性PION的案例.
研究的目的:
- 在CRRT启动后报告第一个已知的非动脉性PION病例.
- 强调在ICU患者中考虑PION的重要性,在CRRT期间突然视力丧失和血管风险因素.
主要方法:
- 一名患有高血压和第四期CKD的52岁男性接受了对代谢性酸和高血症的CRRT.
- 在启动CRRT后,患者经历了突然的,双边的,无痛的视力丧失.
- 诊断工作包括眼科检查,MRI/MRA,以及对巨细胞动脉炎的评估;高剂量的皮质类固醇被给予,但没有效果.
主要成果:
- 在CRRT启动后,该患者在两只眼睛中出现了完全的视力丧失.
- 眼科和神经学成像没有发现任何异常,但MRA显示双侧动脉和右MCA狭窄.
- 非动脉炎性PION的诊断是由于临床表现和排除其他原因而确立的.
结论:
- 在患有血管风险因素的患者中,应怀疑PION在CRRT启动后经历了突然,无痛的视力丧失,即使没有光盘胀.
- 在CRRT开始期间保持稳定的血压对于预防风险人群的PION至关重要.
- 这一案例强调了CRRT和PION之间的新兴关联,需要在ICU环境中保持警.
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