1例创伤弧菌感染致坏死性筋膜炎的诊疗实践并文献分析  

Diagnosis and Treatment Practice and Literature Analysis of Necrotizing Fasciitis Induced by Vibrio Vulnificus Infection:A Case Report

作　　者：陶春 范昔庚 周琳[1] 石敏 胡功利 田塬 王仲书[1] TAO Chun;FAN Xigeng;ZHOU Lin;SHI Min;HU Gongli;TIAN Yuan;WANG Zhongshu(The Fourth People's Hospital of Zigong,Zigong,Sichuan,China 643000)

机构地区：[1]四川省自贡市第四人民医院,四川自贡643000

出　　处：《中国药业》2024年第12期115-119,共5页China Pharmaceuticals

基　　金：四川省自贡市卫生健康委员会科研课题[21yb053]。

摘　　要：目的提高创伤弧菌感染的治疗效果。方法回顾性分析1例创伤弧菌感染致坏死性筋膜炎的诊疗过程。该患者因“烹饪生蚝时被刺伤致右手肿胀、疼痛1 d”入院,予注射用头孢呋辛钠抗感染及降血糖等对症支持治疗3 d,感染仍呈加重趋势,请临床药师会诊。临床药师通过查阅文献,并根据患者的流行病学史、糖尿病史、临床表现、病程特点,考虑为创伤弧菌感染,建议使用注射用头孢曲松钠+左氧氟沙星氯化钠注射液静脉滴注,联合外科手术清创进行抢先治疗,医师采纳。入院第5天,患者脓液细菌培养结果示创伤弧菌,且头孢曲松和左氧氟沙星对其敏感。入院第18天,患者感染症状及体征明显好转,血糖控制稳定,疗程足够,临床药师建议停用抗菌药物,医师采纳。结果入院第30天,患者伤口完全愈合,未诉特殊不适,治愈出院;随访6个月,未见复发。结论创伤弧菌感染致坏死性筋膜炎进展迅速,死亡率高,医务工作者应加强对创伤弧菌感染的认识,及时进行针对性治疗。采用政策干预,对大众进行预防性宣教,可减少创伤弧菌感染的发病率。Objective To improve the therapeutic effect of Vibrio vulnificus infection.Methods The diagnosis and treatment process of a case of necrotizing fasciitis induced by Vibrio vulnificus infection was retrospectively analyzed.The patient was admitted to the hospital for 1 d of swelling and pain in the right hand due to being stabbed while cooking oysters.The physicians provided the patient with symptomatic supportive treatment such as Cefuroxime Sodium for Injection and hypoglycemic drugs for 3 d,but the infection continued to worsen.Therefore,clinical pharmacists were invited for consultation.Based on literature analysis,clinical pharmacists considered that the patient was infected by Vibrio vulnificus according to her epidemiological history,history of diabetes mellitus,clinical manifestations and characteristics of disease course,and suggested using intravenous drip of Ceftriaxone Sodium for Injection and Levofloxacin and Sodium Chloride Injection combined with surgical debridement for preemptive treatment,which were adopted by the physicians.On the 5th day of admission,the bacterial culture of the patient's pus showed Vibrio vulnificus,and ceftriaxone and levofloxacin were sensitive to it.On the 18th day of admission,the patient's infection symptoms and signs improved obviously,blood sugar was stable,and the treatment course was sufficient.The clinical pharmacists suggested discontinuing the use of antibiotics,which was adopted by the physicians.Results On the 30th day of admission,the patient's wound completely healed without any special discomfort,she were cured and discharged,and no recurrence occurred during six months of follow up.Conclusion Necrotizing fasciitis induced by Vibrio vulnificus progresses rapidly with high mortality.Medical personnel should strengthen their knowledge of Vibrio vulnificus infection and provide targeted treatment in a timely manner.Policy intervention and preventive education can decrease the incidence of Vibrio vulnificus infection.

关 键 词：创伤弧菌 坏死性筋膜炎 诊疗实践 文献分析 药学监护 

分 类 号：R969.4[医药卫生—药理学]