气肿性肾盂肾炎致脓毒症休克死亡1例报告  

A case report of death from septic shock due to emphysematous pye-lonephritis

作　　者：姚羽 石培琪 卢建新[1] YAO Yu;SHI Peiqi;LU Jianxin(Department of Urology,Guang’anmen Hospital,China Academy of Chinese Medical Sciences,Beijing100053,China)

机构地区：[1]中国中医科学院广安门医院泌尿外科,北京100053

出　　处：《中国医药导报》2025年第5期184-188,F0003,共6页China Medical Herald

基　　金：中央高水平中医医院临床研究和成果转化能力提升项目-临床科研一体化人才专项(外科团队培育项目)(HLCMHPP2023125)。

摘　　要：气肿性肾盂肾炎(EPN)临床少见,早期缺乏特异性表现,易在短时间内进展成脓毒症休克而危及生命。临床常见发病诱因为血糖未合理控制的糖尿病或存在尿路梗阻。本文回顾性分析1例2024年9月8日就诊于中国中医科学院广安门医院的典型左侧EPN患者,既往2型糖尿病病史10年余,平素血糖控制不佳,入院时即为脓毒症休克、糖尿病性酮症酸中毒昏迷状态,实验室检查明确感染严重,腹、盆CT示左侧肾实质内多发气体样低密度影伴周围渗出,虽然及时给予规范抗感染、抗休克、控制血糖等内科治疗,拟生命体征平稳后行左肾穿刺引流术,但病情进展非常迅速,持续恶化,未能等到手术时机最终因多器官功能衰竭而死亡。通过呈现该病例的凶险病情、诊疗经过及既往相关临床报道,强调对其发病初期的明确诊断及尽早规范抗感染、泌尿外科有效干预等的重要性,提高临床医师对EPN的认识及警惕。尤其对合并糖尿病等基础疾病的患者,平时更应加强血糖管理,避免该类严重并发症的发生。Emphysematous pyelonephritis(EPN)is rare in clinical practice,lacks specific early manifestations,can easily progress to septic shock and endanger life in a short period of time.The common clinical factors are uncontrolled diabetes mellitus and urinary tract obstruction.This article retrospectively analyzes a typical left EPN patient who visited Guang’anmen Hospital,China Academy of Chinese Medical Sciences on September 8,2024.The patient has a history of type 2 diabetes mellitus for over 10 years,his blood sugar control is poor.He is admitted in a state of septic shock,diabetic ketoacidosis coma due to poor blood sugar control.The laboratory examination confirmes severity of infection,abdominal and pelvic CT showes multiple gas-like low-density shadows in left renal parenchyma with peripheral exudate.Although patient receives timely and standard anti-infection,anti-shock,and blood sugar control treatment to stabilize vital signs,he underwent a left nephrectomy drainage operation after his vital signs stabilized.However,the patient’s condition progressed very rapidly and continued to deteriorate,and he does not wait for surgical opportunity and ultimately died of multiple organ failure.By presenting this case’s dangerous condition,treatment course,and previous relevant clinical reports,this article emphasizes the importance of early diagnosis and early standard anti-infection and urological intervention in the initial stage of the disease.It aims to raise clinicians’awareness and vigilance towards emphysematous pyelonephritis.Especially for patients with underlying diseases such as diabetes,they should pay more attention to blood sugar management to prevent the occurrence of such serious complications.

关 键 词：气肿性肾盂肾炎 脓毒症休克 病例报告 

分 类 号：R692.3[医药卫生—泌尿科学]