关节置换术后抗凝药物致双侧肾上腺出血一例报告并文献复习

Bilateral adrenal hemorrhage caused by anticoagulant therapy after joint replacement surgery:One case report and literature review

双侧肾上腺出血是导致原发性肾上腺皮质功能减退的少见原因之一,而因抗凝药物使用导致双侧肾上腺出血则更为罕见。本文介绍了1例双侧膝关节置换手术的患者,术后常规应用抗凝药物预防深静脉血栓,抗凝第8天,出现发热、呕吐、腹痛、严重乏力和低钠血症。直到症状出现后4个月,患者方被确诊为双侧肾上腺出血导致原发性肾上腺皮质功能减退,给予长期糖皮质激素替代治疗后症状消失。本文对关节置换手术后出现肾上腺出血的病例报告进行了汇总和分析,以期能够提高临床医生对此类患者的认识、缩短诊断时间并改善患者预后。

Bilateral adrenal hemorrhage is a rare cause of primary adrenal insufficiency,and bilateral adrenal hemorrhage due to anticoagulant use is even rarer.We describe the case of a 62-year-old woman receiving post total knee arthroplasty anticoagulant therapy who presented fever,vomitting,stomachache,and severe fatigue on the 8th day.It was until 4 months later that the patient was finally diagnosed with adrenal insufficiency resuting from bilateral adrenal hemorrhage,her symptoms were relieved by glucocorticoid replacement therapy.In order to promote the awareness,diagnosis,and mangement of post-surgery anticoagulants induced bilateral adrenal hemorrhage,the clinical characteristics of the reported cases were summarized and analyzed.