尿源性脓毒血症的诊治:附15例报告  

Diagnosis and Treatment of Urosepsis:Fifteen Case Reports

作　　者：路薇薇[1] 费爱华[1] 

机构地区：[1]上海交通大学医学院附属新华医院急诊科,上海200092

出　　处：《中国临床医学》2016年第1期90-91,共2页Chinese Journal of Clinical Medicine

基　　金：2013-2014年度全国临床重点专科项目(编号:国卫办医函【2013】544号)

摘　　要：目的:总结尿源性脓毒血症的早期诊断及治疗经验,以进一步指导临床。方法:回顾分析上海交通大学医学院附属新华医院急诊重症监护室收治的15例尿源性脓毒血症患者的临床资料。结果:15例尿源性脓毒血症患者中,60岁以上11例(73.33%),女性14例(93.33%),首发症状多样化。中段尿细菌培养阳性13例,其中大肠杆菌10例(76.92%),阴沟肠杆菌1例(7.69%),肠球菌2例(15.39%)。尿源性脓毒血症患者的急性生理学与慢性健康状况评分Ⅱ与降钙素原水平呈正相关(r=0.728,P<0.01),与血小板水平呈负相关(r=-0.717,P<0.01)。手术介入组血小板水平明显低于药物治疗组,差异有统计学意义(P<0.05)。结论:老年女性是尿源性脓毒血症的高发人群,首发症状多样化,革兰阴性杆菌是主要致病菌。降钙素原及血小板水平可有效评估尿源性脓毒血症患者的病情。Objective：To summarize early diagnosis and treatment experience of urosepsis so as to guide clinical work further.Methods：The clinical data of 15 patients with urosepsis treated in EICU of Xinhua Hospital,Shanghai Jiao Tong University School of Medicine were analyzed retrospectively.Results：Among 15 patients with urosepsis,there were 11 cases aged over 60（73.33%）,14 female cases（93.33%）,and diversified initial symptoms.The results of mid-stream urine bacterial culture were positive in 13 cases,of which 10 cases were E.coli（76.92%）,1 case was Enterobacter cloacae（7.69%）,2 cases were Enterococcus（15.39%）.Acute physiology and chronic health evaluation Ⅱ score was positively correlated with procalcitonin level（r=0.728,P〈0.01）,and negatively correlated with platelet level（r=-0.717,P〈0.01）.Platelet level in the surgical intervention group was significantly lower than that in drug treatment group,and the difference was statistically significant（P〈0.05）.Conclusions：Elderly women are at high risk of urosepsis.And the initial symptom is diversified,while Gram-negative bacilli are the main pathogens.The condition of patients with urosepsis can be effectively assessed by procalcitonin and platelet levels.

关 键 词：尿源性脓毒血症 降钙素原 血小板 感染 

分 类 号：R691.3[医药卫生—泌尿科学]