创伤弧菌脓毒症1例报道并文献复习
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摘要
目的总结和分析创伤弧菌脓毒症临床治疗经验,提高救治成功率。方法给予创伤弧菌脓毒症1例患者连续性血液净化治疗(CRRT)4 d,抗感染治疗16 d,及外科清创处理,在后期转入烧伤科予双上肢清创换药及扩创、负压封闭引流技术(VSD)引流、植皮等处理。总结救治经验并与其他文献相比较,分析当前最合理的创伤弧菌脓毒症临床治疗方法。结果本例患者双上肢移植皮片成活良好,创面逐渐修复,痊愈出院。重度创伤弧菌脓毒症患者必须及时采取抗感染治疗,有条件时给予血液净化清除血液中有害物质成分,局部创面的处理等多管齐下的控制病情进展和治疗措施,尽快清除感染源和恢复机体自身抗病能力。结论创伤弧菌感染后通过早期干预、血液净化、局部处理等救治措施,能够大大提高救治成功率。
引文
[1]卢中秋,邱巧檬.创伤弧菌脓毒症治疗的研究现状[J].世界急危重病医学杂志,2004,1(3):226-229.
[2]Roland FP.Leg gangrene and endotoxin shock due to vibrio parahaemolyticus-aninfection acquired in New England coastal waters[J].N Engl J Med,1970,282(23):1306.
[3]Hollis DG,Weaver RE,Baker CN,et al.Halophilic Vibrio species isolated from blood cultures[J].J Clin Microbiol,1976,3(4):425-431.
[4]Chang PH,Chuang SK,Tsang T,et al.Cutaneous injury and Vibrio vulnificus infection[J].Emerg Infect Dis,2006,12(8):1302-1303.
[5]田丁,林天龙,徐斌福,等.创伤弧菌外膜蛋白的分离及其抗原性分析[J].福建农业学报,2008(4):337-341.
[6]Klontz KC,Lieb S,Schreiber M,et al.Syndromes of Vibrio Vulnificus In fections.Clinical and Epidemiologie Features in Florida Cases.1981-1987[J].Ann Intern Med,1988,109(4):318-323.
[7]卢中秋,邹长林,李秉熙,等.12例创伤弧菌败血症的流行病学特点[J].中华流行病学杂志,2003,24:900.
[8]Matsuoka Y,Nakayama Y,Yamada T,et al.Accurate diagnosis and treatment of Vibriio vulnificus infection:a retrospective study of 12 cases[J].Braz J Infect Dis,2013,17(1):7-12.
[9]卢中秋,李景荣,创伤弧菌脓毒症研究进展[J].中国危重病急救医学,2005,17(7):439-441.
[10]Shapiro RL,Altekruse S,Hutwagner L,et al.The role of Gulf Coast oysters harvested in warmer months in Vibrio,vulnificus infections in the United States,1998-1996.Vibrio Working Group[J].J Infect Dis,1998,178(3):752-759.
[11]Oishi H,Ura Y,Mitsumizo S,et al.A collective review of Vibrio vulnificus infection in Japan[J].Kansenshogaku Zasshi,2006,80(6):680-689.
[12]Hlady WG,Klontz KC.The epidemiology of Vibrio infections in Florida,1981-1993[J].J Infect Dis,1996,173(5):1176-1183.
[13]卢中秋,张秀华,周铁丽,等.联合应用抗菌药物治疗创伤弧菌感染的实验研究[J].中华传染病杂志,2003,21(5):312-315.
[14]Paul AG,Keri LB,Angela MS.Molecular pathogenesis of Vibrio vulnificus[J].Microbiol,2005,43:118-131.
[15]马骢,郭建巍,郝秀红,等.中国海域分离的创伤弧菌的致病性及其对抗生素的敏感性研究[J].第四军医大学学报,2009,30(6):493-496.
[16]Bowdre JH,Hull JH,Cocchetto DM,et al.Antibiotic efficacy against Vibrio vulnificus in the mouse:superiority of tetracycline[J].J Pharmaclol Exp Ther,1983,225(4):595-598.
[17]Chen SC,Lee YT,Tsai SJ,et al.Antibiotic therapy for necrotizing fasciitis caused by Vibrio vulinificus:retrospective analysis of an 8year period[J].J Antimicrob Chemother,2012,67(2):488-493.
[18]Seal DV.Necrotizing fasciitis[J].Curr Opin Infect Dis,2001,14(2):127-132.
[19]洪广亮,卢中秋.慢性肝病患者并发创伤弧菌脓毒症研究现状[J].中国微生态学杂志,2007,19(2):236-237.
[20]Hong G,Wu B,Lu C,et al.Emergency treatment of 16 patients with necrotizing fasciitis caused by Vibrio vulnificus infection complicated with septic shock[J].Chin Med J(Engl),2014,127(10):1984-1986.
[2]Roland FP.Leg gangrene and endotoxin shock due to vibrio parahaemolyticus-aninfection acquired in New England coastal waters[J].N Engl J Med,1970,282(23):1306.
[3]Hollis DG,Weaver RE,Baker CN,et al.Halophilic Vibrio species isolated from blood cultures[J].J Clin Microbiol,1976,3(4):425-431.
[4]Chang PH,Chuang SK,Tsang T,et al.Cutaneous injury and Vibrio vulnificus infection[J].Emerg Infect Dis,2006,12(8):1302-1303.
[5]田丁,林天龙,徐斌福,等.创伤弧菌外膜蛋白的分离及其抗原性分析[J].福建农业学报,2008(4):337-341.
[6]Klontz KC,Lieb S,Schreiber M,et al.Syndromes of Vibrio Vulnificus In fections.Clinical and Epidemiologie Features in Florida Cases.1981-1987[J].Ann Intern Med,1988,109(4):318-323.
[7]卢中秋,邹长林,李秉熙,等.12例创伤弧菌败血症的流行病学特点[J].中华流行病学杂志,2003,24:900.
[8]Matsuoka Y,Nakayama Y,Yamada T,et al.Accurate diagnosis and treatment of Vibriio vulnificus infection:a retrospective study of 12 cases[J].Braz J Infect Dis,2013,17(1):7-12.
[9]卢中秋,李景荣,创伤弧菌脓毒症研究进展[J].中国危重病急救医学,2005,17(7):439-441.
[10]Shapiro RL,Altekruse S,Hutwagner L,et al.The role of Gulf Coast oysters harvested in warmer months in Vibrio,vulnificus infections in the United States,1998-1996.Vibrio Working Group[J].J Infect Dis,1998,178(3):752-759.
[11]Oishi H,Ura Y,Mitsumizo S,et al.A collective review of Vibrio vulnificus infection in Japan[J].Kansenshogaku Zasshi,2006,80(6):680-689.
[12]Hlady WG,Klontz KC.The epidemiology of Vibrio infections in Florida,1981-1993[J].J Infect Dis,1996,173(5):1176-1183.
[13]卢中秋,张秀华,周铁丽,等.联合应用抗菌药物治疗创伤弧菌感染的实验研究[J].中华传染病杂志,2003,21(5):312-315.
[14]Paul AG,Keri LB,Angela MS.Molecular pathogenesis of Vibrio vulnificus[J].Microbiol,2005,43:118-131.
[15]马骢,郭建巍,郝秀红,等.中国海域分离的创伤弧菌的致病性及其对抗生素的敏感性研究[J].第四军医大学学报,2009,30(6):493-496.
[16]Bowdre JH,Hull JH,Cocchetto DM,et al.Antibiotic efficacy against Vibrio vulnificus in the mouse:superiority of tetracycline[J].J Pharmaclol Exp Ther,1983,225(4):595-598.
[17]Chen SC,Lee YT,Tsai SJ,et al.Antibiotic therapy for necrotizing fasciitis caused by Vibrio vulinificus:retrospective analysis of an 8year period[J].J Antimicrob Chemother,2012,67(2):488-493.
[18]Seal DV.Necrotizing fasciitis[J].Curr Opin Infect Dis,2001,14(2):127-132.
[19]洪广亮,卢中秋.慢性肝病患者并发创伤弧菌脓毒症研究现状[J].中国微生态学杂志,2007,19(2):236-237.
[20]Hong G,Wu B,Lu C,et al.Emergency treatment of 16 patients with necrotizing fasciitis caused by Vibrio vulnificus infection complicated with septic shock[J].Chin Med J(Engl),2014,127(10):1984-1986.