创伤弧菌败血症的临床和流行病学特点  

Clinical features of the septicemia due to vibrio vulnificus infections

作　　者：卢中秋[1] 李秉熙[2] 黄唯佳[1] 程俊彦[1] 周铁丽[3] 

机构地区：[1]温州医学院附属第一医院急诊科,温州325000 [2]温州医学院附属第一医院皮肤科,温州325000 [3]温州医学院附属第一医院细菌室,温州325000

出　　处：《中国急救医学》2003年第7期470-471,共2页Chinese Journal of Critical Care Medicine

基　　金：浙江省教育厅基金资助项目 (2 0 0 2 0 43 8)

摘　　要：目的　探讨创伤弧菌败血症的临床和流行病学特点。方法　总结我院 1998- 5～ 2 0 0 2 - 8临床诊断为创伤弧菌败血症 12例患者的临床资料 ,分析其临床和流行病学特点。结果　 12例患者的男 :女为 3∶1,平均年龄为 5 3 5岁 (36～ 71岁 ) ,发病月份分布在 5～ 10月之间 ,9例 (75 % )患者原有慢性肝病史 ,2例长期嗜酒史 ,1例为健康者。临床主要表现为发热、下肢肿胀、剧烈疼痛、局部红斑、淤血斑坏死、水泡或血疱、蜂窝组织炎等 ,9例 (75 % )患者出现休克以及多脏器功能不全 ,在入院 4 8h内死亡 ,死亡率高达 75 % ,4例水泡液培养出创伤弧菌。结论　创伤弧菌败血症起病急 ,病情进展快 ,死亡率高 ,早期诊断十分重要 ,对高度怀疑创伤弧菌感染的患者应及早经验性应用足量的抗菌药物。Objective To study the clinical and epidemiologic features of vibrio vulnificus infections with septicemia.Methods 12 cases of vibrio vulnificus infections with septicemia were reported from 1998 to 2002.These patient medical records were analysed.Result The ratio of male:female was 3∶1.The mean age of patients with vibrio vulnificus infections was 53.5 years(from,36 to 71). Septicemia occurred in 12 cases from May to October.9 patients(75%)had chronic liver disease.2 patients had alcohol abuse.Septicemia illness occurred in one previously healthy person.All of the patients had an abrupt onset of fever and chills.Secondary cutaneous lesions in the lower extremities occurred,including edematous skin lesion,ecchymosis,high-grade bullae,cellulitis.Intense pain in the lower extremities was reported in all the patients.Shock occurred in 9 cases,and died within 48 hours of admission due to multiple organ dysfunction syndrome.The mortality rate among patients with septicemia was 75%.Vibrio vulnificus was isolated from blood of one patient,and from bullae in 4 patients.Conclusion vibrio vulnificus infections with septicemia caused rapidly progressive skin lesions and sepsis in compromised hosts with chronic liver disease,and was often fatal.Early diagnosis and rapid treatment with antibiotics was very important.Prompt antibiotics treatment with imipenem,third-generation cephalosporin,fluoroquinolone might be lifesaving for this acute and tatal disease.

关 键 词：创伤弧菌 败血症 临床特点 

分 类 号：R516[医药卫生—内科学]