妊娠期重度营养不良合并急性肾盂肾炎致脓毒症、难治性感染性休克、多器官功能衰竭1例  

Severe malnutrition during pregnancy complicated with acute pyelonephritis causing sepsis,refractory septic shock and multiple organ failure:A case report

作　　者：谢芳菲 乔虹[1] 李博雅[2] 袁翠[1] 王芳[1] 孙瑜[2] 李双玲[1] XIE Fangfei;QIAO Hong;LI Boya;YUAN Cui;WANG Fang;SUN Yu;LI Shuangling(.Department of Critical Care Medicine,Peking University First Hospital,Beijing 100034,China;Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院重症医学科,北京100034 [2]北京大学第一医院妇产科,北京100034

出　　处：《北京大学学报(医学版)》2025年第1期202-207,共6页Journal of Peking University:Health Sciences

摘　　要：1病例资料患者女,26岁,主因“停经19周余,恶心呕吐20天,发热伴乏力3天”于2022年10月28日入院。患者月经规律,停经1个月余自测尿人绒毛膜促性腺激素阳性,未建档未产检,孕早期曾大量饮酒,此次发病恶心、呕吐、纳差20 d,未诊治。3 d前出现发热伴乏力,体温最高39.0℃,伴尿痛及尿道烧灼感。外院查白细胞(white blood cell,WBC)6.6×10^(9)/L,血红蛋白(hemoglobin,HGB)65.0 g/L,血小板(platelets,PLT)83.0×10^(9)/L,白蛋白(albumin,ALB)22.4 g/L,血清肌酐(serum creatinine,Scr)81.0μmol/L;尿常规示白细胞满视野;妇科超声提示宫内孕;泌尿系超声示双侧肾盂肾盏扩张。This study reports the diagnosis and treatment of a 26-year-old pregnant woman with severe malnutrition combined with acute pyelonephritis causing sepsis,refractory septic shock and multiple organ failure.A female patient,26 years old,was admitted to hospital mainly due to“menelipsis for more than 19 weeks,nausea and vomiting for 20 days,fever with fatigue for 3 days”.At the end of 19 weeks of intrauterine pregnancy,the patient presented with fever accompanied by urinary tract irritation.Laboratory tests showed elevated inflammatory indicators,and ultrasonography showed bilateral pelvicalyceal dilation.She was diagnosed with acute pyelonephritis,sepsis,acute kidney injury(AKI)and severe malnutrition.After a whole-hospital consultation,the patient was treated with meropenem and vancomycin as antimicrobial therapy,and bilateral nephrostomy drainage was performed simultaneously.After that,the patient suffered a sudden decrease in blood pressure,blood oxygen saturation,and rapid heart rate.Septic shock with multiple organ dysfunction was considered,and she was transferred to intensive care unit(ICU)immediately.After the patient was transferred to ICU,emergency tracheal intubation and ventilator-assisted ventilation were performed.Rapid fluid resuscitation was administered for the patient.While pulse indicator continuous cardiac output(PICCO)monitoring was performed,norepinephrine,terlipressin,and methylene blue were administered to maintain peripheral vascular resistance.Since the patient developed septic cardiomyopathy and cardiogenic shock later,levosimendan and epinephrine were admi-nistered to improve cardiac function.While etiological specimens were delivered,meropenem,teicoplanin and caspofungin were given as initial empiric antimicrobial therapy.Unfortunately,the intrauterine fetal death occurred on the night of admission to ICU.On the 3rd day of ICU admission,a still-born child was delivered vaginally with 1/5 defect of the fetal membrane.On the 6th day of ICU admission,the patient had fever again with el

关 键 词：妊娠并发症 急性肾盂肾炎 脓毒症 休克 重度营养不良 

分 类 号：R714.2[医药卫生—妇产科学]