摘要
目的 总结既往病例诊断治疗情况,结合实际收治病例经验,为类鼻疽伯克霍尔德杆菌(Bulkholderia pseudomallei)感染所致脾脓肿的科学治疗提供依据和参考。方法 以海南医学院第二附属医院为中心,收集类鼻疽伯克霍尔德杆菌感染导致脾脓肿的患者基本资料、临床表现和药物敏感性等病例资料。同时系统检索中文数据库(万方数据库、中国生物医学文献数据库、维普数据库和中国知网)及英文数据库(PubMed、CochraneLibrary、Embase、Web of Science和Ovid)中关于类鼻疽伯克霍尔德杆菌感染致脾脓肿的病例报告。检索时间为建库至2021年1月1日,采用病例报告偏倚评价工具对纳入文献进行质量评估,对全部病例临床表现及治疗预后进行定性分析。结果 收集在海南医学院第二附属医院进行诊断和治疗的病例3例,筛选到符合标准的文献8篇(9个病例),共纳入符合标准的类鼻疽脾脓肿病例12例。类鼻疽脾脓肿患者临床表现大多为发热伴随寒战、左上腹痛等症状,影像学提示脾脓肿通常表现为多发脓肿灶。实验室检查结果提示患者白细胞计数常有不同程度的升高。最常见的并发类鼻疽感染所致脾脓肿的基础疾病为糖尿病。大多数患者对头孢他啶和亚胺培南敏感。采用单药物治疗、药物结合脾切除术、脓肿引流等治疗方法对于类鼻疽脾脓肿患者均有效果,预后多为好转或治愈。结论 类鼻疽脾脓肿患者首选单纯药物抗感染治疗,长期无效应及时进行脾脓肿引流与脾切除术。
Objective To summarize the treatment of previous cases, so as to provide a basis and reference for the standardized treatment plan of splenic abscess due to Burkholderia pseudomallei infection by combining the experience of actual admission cases.Methods There were 3 cases collected in the Second Affiliated Hospital of Hainan Medical University. Meanwhile, studies were identified by using the search strategy and comparing to the inclusion and excluding criteria. A systematic search in Wanfang Database, China Biomedical Literature Database, VIP database and CNKI. COM,PubMed, CochraneLibrary, Embase, Web of Science, and Ovid was conducted, up to January 1, 2021. The bias evaluation was used to evaluate the quality of the included studies. Qualitative analysis was conducted on the clinical features, treatment and prognosis of these cases.Results Three cases that were diagnosed and treated at the Second Affiliated Hospital of Hainan Medical University were collected, and eight literature articles that met the criteria were screened to include a total of 12 cases of rhinophyma-like splenic abscesses that met the criteria. Most patients with melioidosis splenic abscess had fever,accompanied by pain of left upper quadrant. The white blood cell count was elevated to varying degrees. The most common underlying disease complicating splenic abscesses due to nosocomial infection is diabetes mellitus. Most patients are sensitive to ceftazidime and imipenem. Treatment with monotherapy, drugs combined with splenectomy, and abscess drainage are effective in patients with splenic abscesses from rhinophyma-like gangrene, and the prognosis is mostly good or curative.Conclusion For patients with rhinophyma-like splenic abscesses, drug-only anti-infective therapy is preferred, while drainage of splenic abscesses with splenectomy should be performed promptly in cases where long-term drugs are ineffective.
作者
王太成
汪雪媛
蓝雪饶
孙早喜
黄海溶
WANG Tai-cheng;WANG Xue-yuan;LAN Xue-rao;SUN Zao-xi;HUANG Hai-rong(The Second Affiliated Hospital of Hainan Medical University,Haikou,Hainan 570311,China;Hainan Medical University School of Public Health,Haikou,Hainan 571199,China;Hainan Medical University Clinical Skills Center,Haikou,Hainan 571199,China)
出处
《中国热带医学》
CAS
2022年第7期661-666,共6页
China Tropical Medicine
