摘要
目的探讨坏疽性深脓疱疹的临床特点及其在小儿铜绿假单胞菌脓毒症早期诊断中的意义。方法对广州市妇女儿童医疗中心2008年5月至2011年4月收治的11例坏疽性深脓疱疹病例的临床资料进行回顾性分析。结果男8例，女3例；7例小于1岁，年龄最大2岁，均诊断为铜绿假单胞菌脓毒症。皮疹为单一病灶2例，多发病灶9例；病灶位于躯干7例，肛门与会阴5例，四肢5例，头面3例。皮疹最早在病程第2天出现，最晚在第10天出现，平均出疹时间在病程第5天，病程3d内出现6例；入院前出现皮疹7例，住院前平均病程6d。所有患儿均存在发热和多器官功能损害，细菌培养都有铜绿假单胞菌生长，其中血培养阳性7例，其他4例患儿分别是坏疽皮肤组织、疱疹穿刺液或皮肤创面渗液、腹腔穿刺液、胸腔穿刺液培养阳性，最早的细菌培养和药敏结果报告时间是在发病第5天，所有患儿坏疽性深脓疱疹出现的时间都早于培养结果报告时间。患儿人院后立即进行经验性抗生素治疗，9例在早期使用了敏感抗生素，8例进行了外科治疗，4例进行了血液净化治疗。存活9例，死亡2例，住院天数为1—63d，平均30d。结论坏疽性深脓疱疹是铜绿假单胞菌脓毒症的特征性表现，认识和发现这种特征性皮疹有助于早期诊断和使用有效的抗生素，从而改善患儿的预后。
Objective To summarize the characteristics of ecthyma gangrenosum and explore its significance in early diagnosis of pseudomonas aeruginosa sepsis in children. Methods We retrospectively reviewed the medical records of 11 children with ecthyma gangrenosum who were hospitalized at Guangzhou women and children＇s medical center between May 2008 and Apr 2011. Results Eight cases were male and 7 were less than twelve months, the oldest was 2 years old, all of them were diagnosed as Pseudomonas aeruginosa spesis. Two patients had a single lesion, and the others had multiple lesions. Ecthyma gangrenosum located on the trunks in 7 cases, on anogenital areas in 5 cases, on extremities in 5 cases and on faces in 3. The lesions appeared on day 2 to day 10. On average, they developed on day 5. Seven patients developed ecthyma gangrenosum before admission, the course of the illness before admission was 6 days. Fever and multiple organ dysfunction occurred in all the patients and their cultures grew pseudomonas aeruginosa, blood cultures were positive in 8 cases, the others were isolated psudomonas aeruginosa from tissue of the lesion, discharge, ascites, pleural effusion, respectively. The time of ecthyma gangrenosum appeared was earlier than the time of the culture results reported. All of the patients were started empiric antibiotics therapy on admission, the initial antibiotic regimen was appropriate in 9 patients, 8 needed surgical intervention,4 were treated with continuous blood purification. Ten patients survived and 2 died, the hospital stay was from 1 to 63 days, the average was 30. Condusion Ecthyma gangrenosum is a known cutaneous manifestation of pseudomonas aeruginosa sepsis, which is helpful for early diagnosis and treatment, and then the outcome will be improved.
出处
《中国小儿急救医学》
CAS
2012年第6期593-595,共3页
Chinese Pediatric Emergency Medicine
