严重烧伤并发急性出血坏死性肠炎和真菌感染一例  

One case of severely burned patient complicated by acute hemorrhagic necrotizing enteritis and fungal infection

作　　者：赵孝开 娄季鹤[1] 冯新献[2] 吕涛[1] 李树仁[1] 李延仓[1] 王磊[1] 张建[1] 刘冰[1] Zhao Xiaokai;Lou Jihe;Feng Xinxian;Lyu Tao;Li Shuren;Li Yancang;Wang Lei;Zhang Jian;Liu Bing(Department of Burns,the First People＇s Hospital of Zhengzhou,Zhengzhou 450004,Chin)

机构地区：[1]郑州市第一人民医院烧伤科,450004 [2]郑州市第一人民医院普外科,450004

出　　处：《中华烧伤杂志》2018年第8期562-563,共2页Chinese Journal of Burns

摘　　要：2016年6月2日，笔者单位收治1例热铅渣严重烧伤合并休克患者，行抗休克、重症监护及抗感染、脏器保护等治疗。伤后16 d，患者进食饺子后出现急性出血坏死性肠炎，补充血浆及白蛋白，静脉输注奥曲肽抑制肠液分泌、广谱抗生素抗感染，行腹腔穿刺引流，丹参酮ⅡA磺酸钠改善肠道微循环，乌司他丁减轻炎症反应，生长抑素减少肠道出血，伏立康唑抗真菌感染，后患者病情逐渐好转，治愈出院。在危重症患者中胃肠道既是脓毒症的始动器官，又是脓毒症过程中最易受损的靶器官之一，此病例提醒我们严重烧伤患者胃肠道管理的重要性。One severely burned patient, caused by heat lead slag and combined with shock, was hospitalized in our burn unit on 2nd June, 2016. The patient received treatments including anti-shock, intensive care, anti-infection, and organ protection. On post injury day 16, the patient suffered outbreak of acute hemorrhagic necrotizing enteritis after eating dumplings. Plasma and albumin were given, octreotide was intravenously infused to inhibit the secretion of intestinal fluid, the broad-spectrum antibiotics were used for anti-infection, abdominal puncture and drainage were performed, sodium tanshinone ⅡA sulfonate was applied to improve the intestinal microcirculation, ulinastatin was applied to alleviate inflammatory reaction, somatostatin was given to reduce intestinal bleeding, and voriconazole was given for antifungal treatment. The patient gradually recovered and was finally cured and discharged. Among critically ill patients, gastrointestinal tract is not only the initiating organ of sepsis, but also one of the target organs which can be easily damaged during sepsis. This case reminds us the importance of gastrointestinal management in severely burned patients.

关 键 词：烧伤 感染 真菌 急性出血坏死性肠炎 

分 类 号：R644[医药卫生—外科学] R574[医药卫生—临床医学] R519