暴发性紫癜研究进展  

Advances in the research of purpura fulminans

作　　者：李琴琴 雷友才 张小红 朱在勇 邓双南 杨剑 罗鹏 李梅 石庆强 LI Qin-qin;LEI You-cai;ZHANG Xiao-hong;ZHU Zai-yong;DENG Shuang-nan;YANG Jian;LUO Peng;LI Mei;SHI Qing-qiang(Critical Care Medicine Center,People’s Hospital of Chongqing Liangjiang New Area,Chongqing 400020,CHINA)

机构地区：[1]重庆两江新区人民医院危急重症医学中心,重庆400020

出　　处：《海南医学》2025年第5期750-754,共5页Hainan Medical Journal

摘　　要：暴发性紫癜(purpura fulminans,PF)是一种迅速发展的皮肤微血管血栓形成和出血性坏死综合征,同时伴有急性发热、低血压、多个部位出血、弥散性血管内凝血、循环衰竭和多个器官功能衰竭等临床特征。该病的主要病理生理基础是血管内凝血机制异常。皮肤病理特征因微血管凝固,血栓形成,导致紫癜性病变和皮肤坏死。而其他器官因小血管内形成血栓,引起组织缺血、缺氧,进而出现器官功能衰竭。脑膜炎球菌和肺炎链球菌是最常见的细菌诱因,而水痘则是最常见的病毒诱因。根据触发机制分为新生儿型、急性感染型、特发型三种类型。通过支持性治疗、提升对继发性并发症的管理和一些针对性治疗可降低此病的死亡率,然而,对于幸存者来说,往往要截肢并处于残疾状态。本文将从多个方面进行阐述此病的最新进展。Purpura fulminans(PF)is a rapidly progressive syndrome characterized by cutaneous microvascular thrombosis and hemorrhagic necrosis,accompanied by clinical features such as acute fever,hypotension,multi-site bleeding,disseminated intravascular coagulation(DIC),circulatory failure,and multi-organ dysfunction.The main pathophysiological basis is the abnormal mechanism of intravascular coagulation.Skin pathological features due to microvascular coagulation and thrombosis,resulting in purpura lesions and skin necrosis.In other organs,thrombosis in small vessels causes tissue ischemia and hypoxia,resulting in organ failure.Neisseria meningitidis and Streptococcus pneumoniae are the most common bacterial causes,while chickenpox is the most common viral cause.According to the triggering mechanism,purpura fulminans is classified into three types:neonatal type,acute infection type,and special type.The mortality rate can be reduced through supportive care,improving management of secondary complications,and some targeted treatments.However,survivors often require amputations and face long-term disabilities.This article reviews recent advances in the understanding and management of PF from multiple perspectives.

关 键 词：暴发性紫癜 微血管凝固 皮肤坏死 截肢 研究进展 

分 类 号：R554.6[医药卫生—血液循环系统疾病]