产气荚膜梭菌感染致血管内溶血并肝脓肿一例  

A case of intravascular hemolysis with liver abscess caused by Clostridium Perfringens infection

作　　者：朱然 于清霞[1] 林鹏 叶莉萍 Zhu Ran;Yu Qingxia;Lin Peng;Ye Liping(Department of Intensive Care Medicine,The Affiliated Yantai Yuhuangding Hospital of Qingdao University,Yantai 264000,China)

机构地区：[1]烟台毓璜顶医院重症医学科,烟台市264000

出　　处：《中华实验和临床感染病杂志（电子版）》2024年第3期187-190,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的提高临床医师对产气荚膜梭菌罕见并发症的认识。方法回顾性分析烟台毓璜顶医院2023年2月收治的1例产气膜梭菌感染致血管内溶血并肝脓肿患者的临床资料并检索国内外相关文献,对该病的致病机制、临床特征及诊疗进行探讨。结果该老年男性患者因急性胰腺炎合并腹腔感染入院,既往糖尿病病史。入院第2天,患者出现呼吸急促、胸闷憨气及酱油色尿,血红蛋白:63g/L、总胆红素:64.9μmol/L、间接胆红素:55.1μmol/L,提示血管内溶血;血涂片示球形红细胞,血培养报产气荚膜梭菌;腹部CT及超声示肝脓肿,综合考虑为产气荚膜梭菌所致急性血管内溶血合并肝脓肿。在给予充分抗感染、血浆置换及其他对症支持治疗后患者病情好转,转入普通病房。结论产气荚膜梭菌感染合并血管内溶血及肝脓肿是一种罕见的并发症,病死率极高。临床医生应早期识别、诊断和治疗,以改善患者预后。Objective To improve the clinicians'understanding of rare complications of Clostridium perfringens.Methods The clinical data of a patient with intravascular hemolysis and liver abscess caused by Clostridium perfringenes infection who was admitted to Yantai Yuhuangding Hospital in February 2023 was analyzed,retrospectively.Relevant literatures at domestic and abroad were searched to explore the pathogenic mechanism,clinical characteristics,diagnosis and treatment of the disease.Results An elderly man with a history of diabetes was admitted to the hospital due to acute pancreatitis with intra-abdominal infection.On the second day of admission,the patient experienced shortness of breath,chest tightness,and dark urine resembling soy sauce.Laboratory tests(hemoglobin:63 g/L,total bilirubin:64.9μmol/L,indirect bilirubin:55.1μmol/L)indicated intravascular hemolysis,blood smear showed spherocytic red blood cells,and blood culture revealed Clostridium perfringens.Abdominal CT and ultrasound showed a liver abscess,leading to a diagnosis of acute intravascular hemolysis and liver abscess caused by Clostridium perfringens.Conclusions Clostridium perfringens infection accompanied by intravascular hemolysis and liver abscess is a rare complication with an extremely high mortality rate.Clinical physicians should identify,diagnose and treat early to improve the prognosis of the patient.

关 键 词：产气荚膜梭菌 血管内溶血 肝脓肿 

分 类 号：R575[医药卫生—消化系统]