摘要
目的探讨酒精性肝病合并弧菌性脓毒症患者的临床病理特点。方法自2002年8月至2004年8月间符合酒精性肝病合并弧菌性脓毒症早期临床诊断主要依据的患者6例,在应用抗菌药物、补液扩容、升压及1～2h内切开患肢以减压、引流、清创等外科治疗,在总结其临床特点同时,观察患者下肢的临床病理特点及超微结构改变。结果患者首先出现下肢足背或小腿肿胀、剧烈疼痛、局部红斑、数小时内血疱增多、融合成大血疱,皮肤大片淤血斑,下肢病变迅速扩大并向大腿或躯体蔓延,患者同时出现休克、MODS表现。2例下肢皮肤苍白、肌肉色红,肌酸磷酸激酶(CPK)正常或轻度升高,经清创、植皮后保存了患肢。另4例见皮肤脂肪坏死,筋膜肌肉坏死范围广,小血管血栓形成,患者的CPK明显升高,其中2例下肢病变严重,行截去患肢治疗,2例切开患肢以减压、引流、清创等病情好转,因经济原因放弃进一步治疗。6例中4例患者治愈出院。作者通过光镜及电镜对弧菌感染患者下肢病变组织系统观察,包括皮肤、肌肉、脂肪、坐骨神经、股动脉、股静脉,结合大体表现发现创伤弧菌脓毒症患者下肢病变组织病理改变主要表现为炎症性改变。结论及早正确认识下肢临床及病理改变特点对早期临床诊断及治疗十分重要,可有效提高患者生存率。
OBJECTIVE:STUDYING THE CLINICAL CHARATERS AND ULTRASTUCTURE OF VIBRIO PYEMIA PATIENTS'LEGS IN ALCOHOL LIVER DISEASE, TRY TO FIND OUT THE RELATION IN CLINICAL PATHOLOGICAL CHARATERS? TREATMENT WITH PROGNOSIS. METHODS:TAKING SIX PATIENTS WHO COINCIDENT WITH VIBRIO PYEMIA EARLIER PERIOD CLINICAL DIAGNOSIS STANDARDS,THE AFFECTED LEGS' CLINICAL PATHOLOGICAL CHARATERS AND ULTRASTUCTURE WERE OBSERVED AFTER GIVING THEM ANTIBACTERIAL DRUG,CUTTING DOWN AFFECTED LEGS TO DECOMPRESS AND SO ON. RESULTS:THE PATIENTS FIRSTLY SHOWED THE DORSUM OF FOOT OR LEGS SWELLING? INTENSE PAIN? LOCAL ERYTHEMA?BLOOD BLISTER INCREASING IN FEW HOURS?CONFUENCING BIG BLOOD BLISTER AND BIG PIECES CONGESTION ERYTHEMA FORMING. THE LEG'S LESION EXTENDED AND SPREADED TO THIGH OR BODY QUICKLY.VIBRIO VULNIFICUS WERE CULTURED IN FIVE PATIENTS' TISSUE FLUID AND VIBRIO ALGINOLYTICUS WAS CULTURED IN ONE PATIENT' TISSUE FLUID AFTER TWENTY-FOUR HOURS. TWO PATIENTS WHOSE LEGS' SKIN PALE? MUSCLE RED? CPK NORMAL OR HEIGHTENING GENTLY, CONSERVED LEGS AFTER DEBRIDEMENT AND DERMATOPLASTY. SKIN AND FAT NECROSIS? FASCIA AND MUSCLE NECROSIS WIDELY? THROMBOSIS IN SMALL VESSCLE IN OTHER FOUR PATIENTS. THEIR CPK HEIGHTENING OBVIOUSLY. TWO PATIENTS HEALED AFTER TRUNCATING LEGS BUT THE OTHER REFUSED TRUNCATING LEGS AND GO HOME. BY LIGHT AND ELECTRON MICROSCOPE OBSERVING VIBRIO PYEMIA PATIENTS' LEGS BIOPSY TISSUES,INCLUDING SKIN?MUSCLE?FAT?SCIATIC NERVE?FEMORAL ARTERY AND FEMORAL VEIN,WE FOUND OUT THAT THEY MAINLY SHOWED INFLAMMATORY CHANGES. CONCLUSION:IT IS IMPORTANT TO KNOW ABOUT CLINICAL PATHOLOGICAL CHARATERS CORRECTLY FOR EARLY CLINICAL DIAGNOSIS AND TREATMENT. IT CAN HEIGHTEN SURVIVAL RATE OBVIOUSLY.
出处
《岭南急诊医学杂志》
2004年第4期246-248,共3页
Lingnan Journal of Emergency Medicine
基金
温州市科技局计划项目资助(Y2004A004)
浙江省教育厅基金资助项目(20020438)
关键词
酒糟性肝病
弧菌性脓毒症
病理学
并发症
VULNIFICUS
PYEMIA
CLINICAL PATHOLOGICAL CHARATERS
ALCOHOL LIVER DISEASE
