肝移植术后脓毒症:1例报告并国际严重脓毒症和脓毒症休克指南解读

目的  总结肝移植术后脓毒症的治疗经验。方法  回顾性分析2014年9月中山大学附属第三医院外科重症监护室收治的1例肝移植术后脓毒症的临床特征及治疗方法, 并复习国际严重脓毒症和脓毒症休克治疗指南(SSC指南)解读及相关文献。结果  1例50岁男性患者在肝移植术后1 d出现高热、血压下降, 诊断为感染性休克, 经过适当的目标导向性液体复苏、抗感染、血液净化等治疗获得缓解, 患者病情稳定出院。结论  肝移植术后患者易发生感染, 由感染引起的脓毒症病死率高, 因此一旦发生脓毒症, 临床医师要积极地按照SSC指南进行早期的目标导向性治疗及集束化治疗, 根据病原培养结果选用合适的药物, 降低病死率。

Sepsis after liver transplantation:a report of one case and interpretation of International Guidelines for Management of Severe Sepsis and Septic Shock

Objective To summarize the treatment experience of sepsis after liver transplantation. Methods The clinical features and treatment methods of 1 patient developing sepsis after liver transplantation, who was admitted and treated in the Surgical Intensive Care Unit of the Third Affiliated Hospital of Sun Yat-sen University in September 2014, were retrospectively studied. The interpretation of International Guidelines for Management of Severe Sepsis and Septic Shock (SSC Guidelines) and relevant literature were reviewed. Results One male patient at the age of 50 years old developed high fever and decrease of blood pressure at 1 d after liver transplantation, and was diagnosed as septic shock. The symptoms were relieved after the appropriate treatment like goal-directed fluid resuscitation, anti-infection and blood purification, etc. And the patient was discharged in stable conditions. Conclusions It is easy to develop infection after liver transplantation and the fatality rate of sepsis caused by infection is high. Once the sepsis occurs, clinicians must perform early goal-directed therapy and bundle therapy according to the SSC Guidelines positively, and select the appropriate drugs according to the pathogen culture results in order to reduce the fatality rate.