摘要
目的 报告1例脓毒性休克并发对称性外周坏死(SPG)患者的临床资料并复习相关文献,探讨其病情特点、发病机制及治疗措施,以提高临床医师对该病的认识及救治水平。方法 患者,男,60岁,因“左侧腰痛”于2022年7月31日入住海军军医大学附属长海医院,术前诊断为左侧肾上腺恶性肿瘤并侵犯多个脏器及血管,遂在全麻下行腹膜后巨大肿瘤、左半结肠、左肾及左肾上腺、部分胃及胰体尾切除术。由于手术创伤大、出血多且血压低,术后入住重症监护室行输血、补液及升压等治疗。检索美国国立医学图书馆(PubMed)数据库近10年有关SPG的文献,着重探讨其病情特点、发病相关因素及治疗措施。结果 该患者术后第3天因腹腔感染发生脓毒性休克,第4天开始逐渐出现双手及双足对称性缺血性坏死,根据病情特点及临床特征诊断为SPG。共检索到国外英文文献18篇,涉及24例SPG患者,结合本次报告病例共纳入25例患者,其中男10例(40%),女15例(60%),男女比例1∶1.5,男性年龄(48.8±15.1)岁,女性年龄(49.8±16.2)岁,既往均无血管性疾病史。临床特征为对称性双手和(或)双下肢、双足缺血坏死(100%),与脓毒性休克(100%)、微生物感染(52%)、弥散性血管内凝血(DIC)(52%)、肝功能损害(20%)及血管活性药物的应用(80%)等因素存在一定关系。治疗效果不佳,病死率为24%(6/25),存活患者中截肢率高达78.9%(15/19),只有1例行血液吸附治疗有效。结论 脓毒性休克患者发生SPG可能与脓毒性休克、DIC、肝功能损害及天然抗凝剂缺乏等病理生理学改变,以及血管活性药物的作用等因素有关。临床医师需高度重视,以提高SPG的诊治水平。
Objective To report a case of symmetric peripheral gangrene(SPG)in septic shock.The clinical data and related literature were reviewed to discuss its characteristics,pathogenesis and treatment measures,so as to improve clinicians'understanding and treatment of the disease.Methods A 60-year-old male patient was admitted to the Changhai Hospital Affiliated to Naval Medical University on July 31,2022 due to"left side low back pain".Before operation,he was diagnosed with malignant tumor of the left adrenal gland involving multiple organs and blood vessels.Therefore,he underwent resection of huge retroperitoneal tumor,left colon,left kidney,left suprarenal gland,part of stomach and pancreatic body tail under general anesthesia.Due to the large surgical trauma,more bleeding and low blood pressure,he was admitted to the ICU for blood transfusion,fluid infusion and pressure boosting.The literature about SPG in the past 10 years in the database of the National Library of Medicine(PubMed)was searched,and the characteristics of the disease,the related factors of the disease and the treatment measures were emphatically discussed.Results The patient developed septic shock due to intraperitoneal infection on the 3rd day after operation,and gradually developed symmetrical ischemic necrosis of both hands and feet on the 4th day.According to the characteristics of the disease and clinical features,the patient was diagnosed with SPG.A total of 18 foreign English literatures were retrieved,involving 24 SPG patients.In combination with this case,25 patients were included,including 10 males(40%)and 15 females(60%).The male to female ratio was 1:1.5.The average age was(48.8±15.1)years for males and(49.8±16.2)years for females.There was no history of vascular related diseases in the past.The main clinical features were symmetrical ischemic necrosis of both hands and(or)lower limbs and feet(100%),which was related to septic shock(100%),microbial infection(52%),disseminated intravascular coagulation(DIC)(52%),liver function damage(20%)
作者
李俊民
吴鹏
孟岩
常永青
万小健
昌薇
朱科明
Li Jun-Min;Wu Peng;Meng Yan;Chang Yong-Qing;Wan Xiao-Jian;Chang Wei;Zhu Ke-Ming(Department of Critical Care Medicine,Changhai Hospital Affiliated to Naval Medical University,Shanghai 200433,China;Department of Emergency,Xuhui Hospital Affiliated to Fudan University,Shanghai 200030,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2023年第10期1167-1173,共7页
Medical Journal of Chinese People's Liberation Army
基金
上海市科委医学创新项目(20Y11900800)。
关键词
对称性外周坏疽
脓毒性休克
弥散性血管内凝血
抗凝血因子
肝功能损害
血管活性药物
symmetric peripheral gangrene
septic shock
disseminated intravascular coagulation
anticoagulant factors
liver function damage
vasoactive drugs
