影像学表现为假性蛛网膜下腔出血的脓毒症并发多器官功能障碍综合征一例  

A case of sepsis complicated by multiple organ dysfunction syndrome with CT appearance of pseudo-subarachnoid hemorrhage

作　　者：齐艳[1] QI Yan(Department of Critical Care Medicine,the Second Hospital of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院重症医学科,甘肃兰州730030

出　　处：《浙江大学学报(医学版)》2025年第1期115-119,共5页Journal of Zhejiang University(Medical Sciences)

摘　　要：一例39岁男性患者因腹胀、意识不清和无尿入院,头颅计算机断层扫描(CT)示蛛网膜下腔出血(SAH)、弥漫性脑水肿,CT高密度处斑块内对比剂蓄积区高密度影面积为38 HU,初步诊断为急性脑血管病引起SAH、不全性肠梗阻、脓毒症。入院后患者突发双眼上翻、肢体抽搐,降钙素原超过100 ng/mL,血压低,出现感染性休克。采用亚胺培南强化抗感染治疗后,患者降钙素原呈缓慢下降趋势,肾功能恢复正常,腹内压降至正常,尿量逐渐增多,但血小板计数仍呈下降趋势。腰椎穿刺见无色清亮脑脊液流出,脑脊液生化及常规结果均正常,排除SAH及颅内感染可能,考虑头颅CT所示为假性SAH。患者入院第3天,在全身麻醉下行腹腔镜中转剖腹探查术+阑尾切除术+腹腔引流术,术中见阑尾化脓坏疽、肠管表面脓苔附着、腹腔内大量脓液。患者术后出现横纹肌溶解综合征,予连续性肾脏替代治疗后各项指标逐渐恢复至正常水平,意识清楚,复查头颅CT结果正常。患者术后第19天出院,出院3个月随访无特殊不适,再未出现腹痛、腹胀情况。A 39-year-old male patient was admitted to hospital with abdominal distension,unconsciousness,and anuria.Head computed tomography(CT)showed subarachnoid hemorrhage and diffuse cerebral edema.The high-density area of contrast accumulation region in the high-density CT plaque was 38 HU,and the preliminary diagnosis was SAH,incomplete intestinal obstruction,and sepsis caused by acute cerebrovascular disease.After admission,the patient displayed upturned eyes,limb convulsions,serum procalcitonin level exceeding 100 ng/mL,low blood pressure and septic shock.Imipenem was given for intensive anti-infection therapy.After treatment,procalcitonin levels showed a slow decline,renal function,and intra-abdominal pressure returned to normal,urine volume gradually increased,but platelets still showed a downward trend.Lumbar puncture showed colorless and clear cerebrospinal fluid,and the biochemical and routine results of cerebrospinal fluid were normal.SAH and intracranial infection were excluded,and it was considered that the head CT showed pseudo-subarachnoid hemorrhage.On the 3rd day of admission,laparoscopic exploratory laparotomy+appendectomy+abdominal drainage under general anesthesia were performed.During surgery,purulent gangrene in the appendix was found,with pus adhering to the surface of the intestines and a large amount of pus present in the abdominal cavity.Rhabdomyolysis syndrome developed after surgery.After continuous renal replacement therapy,the indicators gradually returned to normal.The patient was conscious,and the head CT results were normal.The patient was discharged from the hospital on the 19th day after surgery,and no special discomfort and abdominal pain and distension occurred during the 3-month follow-up.

关 键 词：假性蛛网膜下腔出血 多器官功能障碍综合征 脓毒症 脓毒症相关性脑病 病例报告 

分 类 号：R445[医药卫生—影像医学与核医学]