血液灌流联合CVVHDF治疗产气荚膜梭菌血流感染致严重脓毒症--附1例报告  

Hemoperfusion combined with continuous veno venous hemodiafiltration in Clostridium perfringens bloodstream infection caused severe sepsis: one case report

作　　者：亢翠翠[1] 吴铁军[1] 张丽娜[1] 田锁臣[1] 田辉[1] 邹秀丽[1] Kang Cuicui;Wu Tiejun;Zhang Lina;Tian Suochen;Tian Hui;Zou Xiuli(Department of Critical Care Medicine,Liaocheng People's Hospital,Liaocheng 252000,Shandong,China)

机构地区：[1]聊城市人民医院重症医学科,山东聊城252000

出　　处：《实用检验医师杂志》2022年第1期106-109,共4页Chinese Journal of Clinical Pathologist

摘　　要：目的采用血液灌流(HP)联合连续性静脉-静脉血液透析滤过(CVVHDF)救治1例产气荚膜梭菌血流感染合并多器官功能衰竭(MOF)患者,报告该患者的救治过程、HP及CVVHDF实施方案等,探讨HP联合CVVHDF在治疗中发挥的作用。方法聊城市人民医院2021年5月6日收治1例产气荚膜梭菌血流感染合并MOF的患者,诊断明确后给予HP联合CVVHDF治疗,连续治疗3次,监测患者治疗前后的感染指标及器官功能指标。结果患者为46岁男性,因“发热3 d,意识不清10 h”入院,经查体、血常规、颅脑、胸部、腹部CT、心脏超声等检查,诊断为脓毒症、MOF、肺部感染、脑梗死、膀胱炎。给予扩容补液,血培养连续3次报告厌氧瓶阳性,检出产气荚膜梭菌;给予抗感染、血液净化联合HP、免疫调理、营养支持、康复锻炼、隔离防护等治疗措施。通过HP联合CVVHDF治疗,患者的感染指标及器官功能指标均明显好转,最终于6月28日康复出院。结论HP联合CVVHDF方法在该患者的治疗中效果确切,值得临床推广应用,进一步研究其在大宗病例资料中的作用。Objective To report the treatment process and implementation plans of hemoperfusion(HP)combined with continuous veno venous hemodiafiltration(CVVHDF)for a patient with Clostridium perfringens caused bloodstream infection and multiple organ failure(MOF),so as to explore the role of HP combined with CVVHDF in the treatment of the patient.Methods A patient with Clostridium perfringens caused bloodstream infection combined with MOF was admitted to Liaocheng People's Hospital on May 6,2021.The patient was given HP combined with CVVHDF for three times after a clear diagnosis.The infectious indexes and organ function indicators of the patients were monitored before and after treatment.Results The patient was 46-year-old male,who was admitted to the hospital due to"fever for 3 days and unconsciousness for 10 hours".He was diagnosed as sepsis,MOF,pulmonary infection,cerebral infarction and cystitis after physical examination,routine blood test,CT of the skull,chest,and abdomen,and cardiac ultrasound.On the treatment,expansion fluid rehydration was given,blood culture was positive for three consecutive times,Clostridium perfringens was deteced by 100%.At the same time,the patient was given anti-infection treatment,blood purification combined with HP,immune conditioning,nutritional support,rehabilitation exercise,isolation and protection and other treatment measures.The infection indexes and organ function indexes of the patient were improved significantly by HP combined with CVVHDF treatment,and the patinet was descharged on June 28.Conclusion The treatment of HP combined with CVVHDF in this patient is accurate and deserved,and the role in the bulk case data requires further investigation.

关 键 词：血液灌流 连续性静脉-静脉血液透析滤过 产气荚膜梭菌 脓毒症 

分 类 号：R459.7[医药卫生—急诊医学]