接触海水感染创伤弧菌引发脓毒症患者救治成功病例1例分析  

Successful treatment of a patient with sepsis caused by infection with Vibrio vulnificus following contact with seawater:a case analysis

作　　者：王婷 林泽辉[1] 李泉[1] 张汉洪[1] WANG Ting;LIN Zehui;LI Quan;ZHANG Hanhong(Hainan Traditional Chinese Medicine Hospital,Haikou,Hainan 570203,China)

机构地区：[1]海南省中医院,海南海口570203

出　　处：《中国热带医学》2024年第3期353-357,共5页China Tropical Medicine

基　　金：国家中医药管理局张汉洪全国名老中医药专家传承工作室。

摘　　要：创伤弧菌感染对人具有高致残率、致死率,本文总结1例创伤弧菌脓毒症患者的诊断、治疗情况,帮助临床工作者在早期识别创伤弧菌感染,优化治疗方案,为创伤弧菌感染相关研究提供临床依据。2022年9月,海南省中医院急诊科收治1例创伤弧菌感染引发脓毒症患者,对其进行临床治疗与分析报告,同时查阅创伤弧菌文献,分析总结创伤弧菌脓毒症治疗方法。患者男,61岁,2022年9月23日—10月8日于急诊科治疗,经脓汁和创伤感染标本细菌学检查识别为创伤弧菌感染,于是针对性予美罗培南注射剂+左氧氟沙星注射液联合抗感染、早期行床边连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)消除炎症风暴方案控制脓毒症,并进行外科清创治疗。患者病情平稳后转入血管外科,于10月27日、11月19日2次进行清创术+左下肢植皮术,12月10日进行清创术+左下肢第3次植皮术+截趾术,术后病情好转出院。目前随访患者生活自理,患肢能自主活动。对创伤弧菌感染引发脓毒症的治疗应重视炎症级联反应,可早期进行CRRT消除炎症因子,敏感抗生素抗炎,外科清创介入治疗,启动多学科联动对患者进行治疗。Vibrio vulnificus infection has a high disability rate and fatality rate.This paper summarized the diagnosis and treatment of a case of Vibrio vulnificus sepsis to help clinicians in the early detection and optimization of treatment options for such infections,thereby providing a clinical reference for related research.In September 2022,a case of sepsis caused by Vibrio vulnificus infection was admitted to the Emergency Department of Hainan Hospital of Traditional Chinese Medicine.Clinical treatment was conducted,and the report was analyzed.Meanwhile,Vibrio vulnificus literature was reviewed to analyze and summarize the treatment methods of Vibrio vulnificus sepsis.The 61-year-old patient was treated in the Emergency Department from September 23 to October 8,2022,during which bacteriological examination of pus and wound infection samples identified the infection as being caused by Vibrio vulnificus.Therefore,targeted treatment with meropenem injection plus levofloxacin injection was administered for the infection,and early CRRT(continuous renal replacement therapy)was implemented to control the inflammatory cytokine storm of sepsis,and surgical debridement treatment was performed.After the patient's condition stabilized,the patient was transferred to the vascular surgery department,where two debridement+left lower limb skin grafting procedures were performed on October 27 and November 19.Then a third debridement+left lower limb third skin grafting+toe amputation was performed on December 10,the patient was discharged with improved condition post-surgery.At present,the patient can live independently and can move the affected limb autonomously.In clinical diagnosis and treatment of sepsis caused by Vibrio vulnificus infection,attention should be paid to the inflammatory cascade reaction.CRRT can eliminate inflammatory factors in the early stage,sensitive antibiotics for anti-inflammatory,surgical debridement interventional treatment,and multi-disciplinary linkage can be initiated to treat patients with Vibrio vulni

关 键 词：创伤弧菌 脓毒症 抗生素 血液滤过 外科 

分 类 号：R378.3[医药卫生—病原生物学]