摘要
目的 探讨弧菌性脓毒血症的早期临床诊断及早期治疗方法。方法 将符合弧菌性脓毒血症临床诊断的患者根据时间顺序分为A、B两组 ,A组 5例应用抗菌药物、补液扩容、多巴胺升压、护肝治疗及其他对症处理 ;B组 5例应用上述治疗同时 ,入院后 1～ 2h切开患肢皮肤减压、引流 ,清创、植皮或截肢治疗。总结两组的临床资料 ,并对结果及疗效进行对比分析。结果 7例患者血疱液、培养出致病性弧菌病原体。A组患者 4 8h内死亡 ,B组 2例下肢病变轻的患者经清创、植皮后保存了患肢 ,2例下肢病变严重者行截肢治疗 ,均治愈出院 ,1例虽病情好转 ,但因放弃治疗而死亡。结论 根据其主要临床及流行病学特点作为弧菌性脓毒血症的早期诊断依据 ,确诊率高 ,早期临床诊断、早期抗菌药物结合早期外科手术切开减压引流 ,及时清创和截肢治疗弧菌性脓毒血症有显著的疗效。
Objective To study the early clinical diagnosis and treatment of vibrio pyemia .Methods The early clinical diagnosis standard: the patients fell ill during April to July who had excessive drinking or chronic liver disease.They firstly showed acute fever; the dorsum of feet or legs swelling; intense pain; local erythema; blood blister increasing in few hours; big blood blister and big pieces congestion erythema forming .The leg's lesion extended and spreaded to thigh or body quickly. They showed hypotension , shock, even MODS. 10 patients were submitted to either standard therapy (B group, consisting of antibiotics, fluid replacement, heightening blood pressure and so on.)plus cutting down affected legs to decompress, drain and debride or standard therapy(A group).Clinical manifestation and result after treatment in each group were comparatively analysed. Results Vibrio vulnificus were cultured in seven patients' tissue fluid. The patients with standard therapy all died in 48 hours in A group. In B group, two patients conserved legs after debridement and skin grafting. two serious patients healed after truncating legs. Conclusion It is more correct to diagnosis vibrio pyemia according to our early clinical diagnosis standard. It is effective in patients with vibrio pyemia by early clinical diagnosis,early antibiotics and early operation( cutting down affected legs to decompress, draining and debriding).
出处
《中国急救医学》
CAS
CSCD
北大核心
2004年第9期652-654,共3页
Chinese Journal of Critical Care Medicine
基金
浙江省教育厅基金资助项目 ( 2 0 0 2 0 43 8)
