34例创伤弧菌脓毒症患者的流行病学特点及临床诊治

目的 分析总结创伤弧菌脓毒症的流行病学特点、临床表现、临床诊断及治疗方案.方法 制定专用调查表,收集温州医学院附属第一医院1995年5月至2008年8月期间临床诊断为创伤弧菌脓毒症且资料完整的患者,对其流行病学及临床资料等进行分析.结果 1995年5月至2008年8月期间温州医学院附属第一医院共收治34例资料完整的创伤弧菌脓毒症患者,男女比例为4.7:1,76.5%的患者并存慢性肝病,多发病于4-11月.本组患者临床多表现为急起发热,肢端特征性血性大疱样皮损、低血压休克及多器官功能不全(MODS),死亡率47.1%以上.创伤弧菌脓毒症的早期临床诊断标准包括:患者4-11月急起发热,肢体特征性血性大疱样皮损、甚至大范围皮肤及肌肉坏死,迅速出现低血压休克及多器官功能不全(MODS),有慢性肝病或长期嗜酒史以及近1～2周内有生食海鲜或接触带菌海水史等.尽早联合应用三代头孢菌素及喹诺酮类药物,结合早期外科手术切开减压引流、清除坏死组织及对症支持的综合治疗方案有助于改善患者预后.结论 创伤弧菌感染脓毒症病情进展快,病死率高,早诊断、早期联合抗菌药物治疗结合早期外科手术治疗是提高生存率的关键.

Septic patients caused by Vibrio vulnificus: epidemiology, clinical findings, diagnosis and treatment

Objective To study epidemiology, clinical findings, diagnosis and treatment of sepsis caused by Vibrio vulnificus. Method Patientss with Vibrio vulnificus sepsis were collected from 1995 to 2008. The medical records including epidemiological and clinical data were analyzed. Results The male-to-female ratio of 34cases was 4.7:1 and 76. 5% of these patients suffered from chronic liver disease. Most patients occurred from April to October with signs of abrupt fever, characteristic cutaneous lesions, hypotension and progressive multiple organ disfunction syndrome (MODS). The mortality was over 47.1% . The criteria proposed for early diagnosis of Vibrio vulnificus sepsis were abrupt onset with fever during the period from April to November, characteristic cutaneous lesions, such as the most commonly occurred haemorrhagic bullae on the extremities or even extensive necrosis of skin and muscular tissue, progressive hypotension or shock accompanied by MODS, pre-existing liver disease or chronic abuse of alcohol, and consumption of raw seafood or exposure to seawater within 12 week. Early administration of the third-generation cephalosporins with the quinolones in full dosage, aggressive wound debridement,appropriate dermoplasty and supportive care contribute to a better outcome. Conclusions Vibrio vulnificus sepsis progresses rapidly with high mortality. Early diagnosis, rapid treatment with prompt antibiotics and aggressive surgery treatment are very important to improve the outcome.