摘要
目的探討細菌性肝膿腫併發感染性休克的臨床特點、常見致病菌及治療效果。方法回顧性分析2011年1月~2012年12月本院ICU6例細菌性肝膿腫併發感染性休克患者的臨床資料,其中男性4例女性2例,年齡46~68歲(平均59.3歲);基礎疾病:2例伴高血壓病、1例伴糖尿病、1例伴冠心病、1例合併膽道疾病;3例併發ARDS,需行機械通氣治療;1例併發AKI,需行持續血液濾過治療。結果細菌性肝膿腫突出的臨床表現主要為發熱並休克狀態及體查發現上腹壓痛/肝區叩痛(100%);早期行腹部超聲和CT掃描檢查,可及時得到確診;常見致病菌為肺炎克雷伯杆菌(83%)感染;全部病例均於超聲或CT引導下行經皮肝膿腫穿刺引流術,效果良好,平均住院天數23天,均痊癒出院。結論臨床醫生應熟悉細菌性肝膿腫的臨床特點,重視體格檢查;超聲和腹部CT掃描有助早期確診;嚴格按照嚴重感染/感染性休克治療的臨床路徑,結合正確使用抗生素和腹部超聲或CT引導下經皮肝膿腫穿刺引流術治療細菌性肝膿腫,效果良好,安全性高。
Objective Investigate the clinical features,common pathogen and treatment of pyogenic liver abscess complicated by septic shock.Methods A retrospective analysis of 6 cases of pyogenic liver abscess complicated by septic shock admitted in ICU from January 2011 to December 2012,which includes 4 males and 2 females,age ranging from 46 to 68 years(mean age 59.3 years),underlying disease including hypertension in 2 cases,diabetes mellitus in one patient,coronary heart disease in one case and biliary tract disease in one patient.3 cases complicated with ARDS and required mechanical ventilation,1 patient complicated with AKI and treated with continuous renal replacement therapy.Results Pyogenic liver abscess prominent clinical manifestations were fever and shock with physical examination revealing abdominal tenderness(percussion pain in liver area 100%).Early diagnosis can be obtained by abdominal ultrasound and CT scan.Common pathogenic bacteria was Klebsiella pneumoniae infecting 83%,and one case was caused by Escherichia Coli infection.All the patients underwent ultrasound or CT guided percutaneous liver abscess drainage,treated with appropriate antibiotics and effectively cured with average hospital stay of 23 days.Conclusion Clinicians must be familiar with clinical features of pyogenic liver abscess and emphasis on the importance of the physical examination.Early diagnosis can be derived by abdominal ultrasound and CT scan.Following severe infection or septic shock therapy clinical pathways in combination of appropriate antibiotics use and abdominal ultrasound or CT guided percutaneous abscess drainage,pyogenic liver abscess can be cured safely and effectively.
作者
黃慧明
黎啟盛
蕭鳳儀
許少峰
WONG Wai Meng;LAI Kai Seng;SIO Fong I;HOI Sio Fong(Intestive Care Unit,Kiang Wu Hospital,Macao,China)
出处
《镜湖医学》
2013年第2期39-42,共4页
MEDICAL JOURNAL OF KIANG WU
作者简介
通訊作者:黎啟盛,E-mail:aedchief@kwh.org.mo。
