CAJ | 학술논문

目的分析小儿社区获得性铜绿假单胞菌败血症致感染性休克的临床特征及干预过程.方法通过回顾病案记录,对患儿的诊断,抗生素应用,死亡情况,休克临床过程,呼吸支持,化验等方面进行分析.结果 9例并发脓毒性休克的铜绿假单胞菌败血症患儿中,8例死亡.9例均有发热,其中3例伴咳嗽或腹泻,3例并发皮肤坏疽性深脓疱;死亡或血培养结果前,均未考虑铜绿假单胞菌感染.在入院时9例中仅3例接受敏感抗生素治疗,转入ICU后,均没有接受联合抗感染治疗,9例中有7例接受单一敏感抗生素治疗.人院到发生休克时间为0～21 h,平均5.1 h;休克到死亡时间为1～32 h,平均13.8h.9例均因发生休克而转入ICU,因转科而延误抗休克时间为25～80 min,平均49.3 min,且转科前仅2例诊断休克并行抗休克治疗,转入ICU后仅5例诊断休克,3例给予抗休克治疗.9例均用血管活性药物,其中6例用升压剂量多巴胺;8例死亡者休克状态一直持续至死亡.其中6例死亡直至心跳骤停才插管上呼吸机.血白蛋白严重下降,为(11.1～23.7)g/L,平均18.5 g/L,血CRP显著升高,波动于(89～318)mg/L,平均179.4 mg/L,血白细胞计数下降,为(0.1～5.0)×109/L,平均2.1 x 109/L,6例并发DIC.结论小儿社区获得性铜绿假单胞菌败血症,发病之初仅有发热、咳嗽、腹泻等非特异性表现,临床医生对感染严重程度常估计不足,甚少选用有效抗生素.一旦发生感染性休克,即呈暴发性,大多错过抢救时机,于短期内死亡.对于高危患儿,应经验性选择抗绿脓假单胞菌治疗;同时培训一线临床医生早期识别休克,争分夺秒地抗休克.
목적 분석소인사구획득성동록가단포균패혈증치감염성휴극적림상특정급간예과정.방법 통과회고병안기록,대환인적진단,항생소응용,사망정황,휴극림상과정,호흡지지,화험등방면진행분석.결과 9례병발농독성휴극적동록가단포균패혈증환인중,8례사망.9례균유발열,기중3례반해수혹복사,3례병발피부배저성심농포;사망혹혈배양결과전,균미고필동록가단포균감염.재입원시9례중부3례접수민감항생소치료,전입ICU후,균몰유접수연합항감염치료,9례중유7례접수단일민감항생소치료.인원도발생휴극시간위0～21 h,평균5.1 h;휴극도사망시간위1～32 h,평균13.8h.9례균인발생휴극이전입ICU,인전과이연오항휴극시간위25～80 min,평균49.3 min,차전과전부2례진단휴극병행항휴극치료,전입ICU후부5례진단휴극,3례급여항휴극치료.9례균용혈관활성약물,기중6례용승압제량다파알;8례사망자휴극상태일직지속지사망.기중6례사망직지심도취정재삽관상호흡궤.혈백단백엄중하강,위(11.1～23.7)g/L,평균18.5 g/L,혈CRP현저승고,파동우(89～318)mg/L,평균179.4 mg/L,혈백세포계수하강,위(0.1～5.0)×109/L,평균2.1 x 109/L,6례병발DIC.결론 소인사구획득성동록가단포균패혈증,발병지초부유발열、해수、복사등비특이성표현,림상의생대감염엄중정도상고계불족,심소선용유효항생소.일단발생감염성휴극,즉정폭발성,대다착과창구시궤,우단기내사망.대우고위환인,응경험성선택항록농가단포균치료;동시배훈일선림상의생조기식별휴극,쟁분탈초지항휴극.
Objective This study sought to analyze the clinical manifestations and intervention of fulminant septic shock in community-acquired Pseudomonas aeruginosa septicemia.Methods We retrospectively reviewed the medical records for diagnosis,antibiotic therapy,clinical course of septic shock,respiratory support,laboratory data etc.Results Eight of nine cases with P.aeruginosa septic shock died.Fever(nine cases)and cough(three cases) or diarrhea (3 cases) were the 2 most common initial symptoms,three cases developed skin gangrenosum later.Pseudomonas aeruginosa infection was not considered in any of the cases before death or blood culture showed positive result.Only 3 cases were initially treated with susceptible antibiotic regimen but no antipseudomonas combination therapy was applied,susceptible antibiotic monotherapy was applied in 7 cases after transfer to the ICU.The mean latency of shock occurrnence was 5.1 hours (range 0 to 21 hours) after admission,the mean duration from the occurrence of shock to death was 13.8 hours(range,1-32 hours).All the patients were transfer red to ICU for shock,the appropriate resuscitation of shock patients was delayed by 49.3 minutes (range 25-80minutes) by transfer.Only two cases were diagnosed and treated for shock on admission;after transferred to ICU,only 5 patients were diagnosed as having shock,and only 3 received anti-shock treatment.Eight of the patients died of persistent shock.In 6 patients who died,mechanical ventilation was not applied until cardiac arrest occurred.All the patients had hypoalbuminaemia,elevated serum C-reactive protein concentration,leukopenia and 6 cases had DIC.Condusion The initial presentation of the cases with community-acquired Pseudomonas aeruginosa septicemia was nonspecific with fever and cough or diarrhea.Clinicians often usderestimated the severity of the infection,few patients received effective antimicrobial therapy.The authors suggest that an anti-pseudomonas antibiotic should be included in the initial empiric antibiotic resimen to cover P.aemginosa high-risk patients;the front-line clinician should be educated for early recognition and aggressive resuscitation of P infection.aeruginosa septicemia.