气肿性肾盂肾炎合并脓毒性休克诊治分析  

Diagnosis and treatment of emphysema pyelonephritis with septic shock

作　　者：赵云华 顾金萍[1] 于健[1] Zhao Yunhua;Gu Jinping;Yu Jian(Department of ICU,the Second Affiliated Hospital of Dalian Medical University,Dalian,China)

机构地区：[1]大连医科大学附属第二医院重症医学科

出　　处：《实用休克杂志（中英文）》2019年第3期155-158,共4页Journal of Practical Shock

摘　　要：目的探讨气肿性肾盂肾炎(EPN)的病因及诊治方法,提高EPN的早期诊断及合并脓毒性休克的治疗水平。方法8例EPN患者均行超声、CT及实验室检查,其中EPN1级2例,1例为双侧多囊肾伴出血;EPN2级1例,伴真菌球及气肿性膀胱炎;EPN3级4例,肾周脓肿3例,伴肝脓肿及肾内结石1例,左肾血肿1例;EPN4级1例,双肾呈“菠萝征”。微生物学检查:大肠埃希菌6例,肺炎克雷伯杆菌1例,光滑假丝酵母菌1例。8例均予抗感染治疗及经皮肾穿刺引流术,1例行经皮肾镜碎石术及经皮肝脓肿及肾脓肿穿刺引流术,同时予保护器官功能及生命支持等治疗。结果2例EPN1级及1例EPN2级的患者,病愈。4例EPN3级,2例院内7d死亡,1例签字离院,院外死亡,另1例院内治疗25d后好转出院,院外随访1个月,病愈。1例EPN4级的患者,院内6h死亡。结论EPN最常见病原菌是革兰氏阴性杆菌,真菌亦可单独致病或形成真菌球致泌尿系梗阻形成EPN。CT是诊断EPN最有效的方法。EPN1级及EPN2级的患者经内科治疗或联合经皮肾穿刺引流术预后较好。EPN3级及EPN4级的患者常合并多个危险因素及脓毒性休克,应遵守EPN的分级诊治原则及脓毒症休克急诊治疗指南,以降低病死率。Objective To explore the etiology, diagnosis and treatment of EPN, aiming to improve the doctors early diagnosis and treatment of EPN. Methods Ultrasound, CT and microbiological examination were performed in 8 patients with EPN, including 2 cases of EPN1 and 1 case of bilateral polycystic kidney with hemorrhage;1 case of EPN2 with fungal ball and emphysema cystitis;4 cases of EPN 3 with perirenal abscess, 1 case of liver abscess and intrarenal stones, 1 case of left renal hematoma;1 case of EPN4, and " pineapple sign" in both kidneys. 5 cases of Escherichia coli, 1 case of Klebsiella pneumoniae, and 1 case of Candida glabrata. 8cases were treated with anti - infective treatment and percutaneous nephrolithotomy, 1 case underwent percutaneous nephrolithotomy and percutaneous liver abscess and renal abscess puncture drainage, and also protected organ function and life support treatment. Results Two patients with EPN1 and one EPN2 were cured. 3 cases of EPN3, 1 case died in 7 days, 1 case died in 8 days in the hospital, and 1 case was discharged from hospital after 25 days of in - hospital treatment. The patient was followed up for one month and recovered. 1 patient with EPN4 died after 6 hours. Conclusions The most common pathogen of EPN is Gram - negative bacilli, and fungi can also cause disease alone or form fungal ball - induced urinary obstruction to form EPN. CT is the most effective way to diagnose EPN. Patients w让h EPN1 and EPN2 have a better prognosis through medical treatment or combined percutaneous nephrolithotomy. Patients with EPN3 and EPN4 often have multiple risk factors and multiple organ dysfunction syndrome. It should follow the principle of EPN classification and treatment and the principle of treatment for critically ill patients to reduce the mortality rate.

关 键 词：气肿性肾盂肾炎 脓毒性休克 光滑假丝酵母菌 经皮肾穿刺引流术 

分 类 号：R459.7[医药卫生—急诊医学] R692.7[医药卫生—治疗学]