脓毒症合并自发性脾破裂出血1例报告  

Sepsis with spontaneous splenic rupture and hemorrhage:A case report

作　　者：柳舟[1] 夏文芳[1] 詹丽英[1] 方小雨 张亮[2] 詹娜[3] 禹荣 黄丽[4] 朱垒 LIU Zhou;XIA Wenfang;ZHAN Liying;FANG Xiaoyu;ZHANG Liang;ZHAN Na;YU Rong;HANG Li;ZHU Lei(Department of Critical Care Medicine,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Radiology,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Pathology,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Gastroenterology,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Hepatobiliary Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院重症医学科,武汉430060 [2]武汉大学人民医院放射科,武汉430060 [3]武汉大学人民医院病理科,武汉430060 [4]武汉大学人民医院消化内科,武汉430060 [5]武汉大学人民医院肝胆外科,武汉430060

出　　处：《临床肝胆病杂志》2023年第8期1926-1931,共6页Journal of Clinical Hepatology

基　　金：湖北省重点实验室开放项目(2021KFY018)。

摘　　要：脓毒症所致重症感染往往导致多器官功能不全,如心功能不全、肾功能不全、肝功能损伤、脓毒症脑病、凝血功能障碍等。严重感染不仅导致全身炎症反应风暴,同时可诱发脾脓肿形成,甚至自发性脾破裂出血。自发性脾破裂起病隐匿,症状不典型,通常无明显外伤病史,临床容易漏诊。本例脓毒症患者突发左上腹疼痛、血红蛋白进行性下降,紧急完善腹部CT检查,考虑脾破裂出血。剖腹探查术术中发现腹腔大量积血,脾周血肿明显伴脾脏包膜撕裂,遂行全脾切除术。病理提示:脾脏慢性炎症细胞浸润,考虑脾脓肿伴出血。术后患者血色素平稳,腹痛症状明显好转。Severe infections due to sepsis often result in multi-organ insufficiency,such as cardiac insufficiency,renal insufficiency,hypohepatia,septic encephalopathy,coagulation dysfunction etc.Severe infections not only cause inflammatory storm,but also induce spleen abscess,and even combined with spontaneous splenic rupture hemorrhage.Spontaneous splenic rupture has an insidious onset,usually without a history of trauma,and is easily missed diagnosis.In this case,the patient with sepsis had sudden onset of abdominal pain and progressive decrease in hematocrit,thus the abdominal CT was immediately performed.The perisplenic mixed high-density shadow indicated splenic hemorrhage.After consultation with the department of hepatobiliary surgery,emergency dissection was performed.Splenic hematoma and laceration were found during the operation,thus total splenectomy was conducted.Pathological indicated chronic inflammatory cell infiltration of spleen,spleen abscess with bleeding.After operation,the patient’s hematocrit was stable,abdominal pain improved significantly,and he was discharged from hospital after systematic therapy.

关 键 词：脓毒症 脾破裂 出血 金黄色葡萄球菌 脾切除术 

分 类 号：R657.62[医药卫生—外科学] R459.7[医药卫生—临床医学]