化脓性链球菌致脓毒症休克并右上肢坏死性筋膜炎1例报告

化脓性链球菌致脓毒症休克并右上肢坏死性筋膜炎1例报告

罗理云,李烽辉,王颖菁,姚隽,彭环庆,唐钟祥,林辉文,陈海敏,曾昭上,刘炜枫,彭志允

南海区中医院,广东省中西医结合医院重症医学科,广东省中西医结合医院重症医学科,广东省中西医结合医院手足外科,广东省中西医结合医院重症医学科,广东省中西医结合医院重症医学科,广东省中西医结合医院重症医学科,广东省中西医结合医院重症医学科,广东省中西医结合医院重症医学科,广东省中西医结合医院重症医学科,广东省中西医结合医院重症医学科

收稿日期:2018-04-12 修回日期:2018-06-08 出版日期:2018-05-25

Septic Shock and Necrotizing Fasciitis of Right Upper Limb Due to Streptococcus Pyogenes：a Case Report

luo liyun,LI Fenghui,WANG Yingjing,YAO Jun,PENG Huanqin,TANG Zhongxiang,LIN Huiwen,CHEN Haimin,ZENG Zhaoshang,LIU Weifeng and PEMG Zhiyun

Hospital of Integrated Traditional and Western Medicine of Guangdong Province,,广东省中西医结合医院重症医学科,广东省中西医结合医院重症医学科,广东省中西医结合医院手足外科,广东省中西医结合医院重症医学科,广东省中西医结合医院重症医学科,广东省中西医结合医院重症医学科,广东省中西医结合医院重症医学科,广东省中西医结合医院重症医学科,广东省中西医结合医院重症医学科,广东省中西医结合医院重症医学科

Received:2018-04-12 Revised:2018-06-08 Online:2018-05-25

摘要/Abstract

摘要： 本文报道1例化脓性链球菌感染右手导致脓毒症休克并上肢坏死性筋膜炎，治疗采取早期“重拳出击”抗感染治疗策略，明确病原体后采用“降阶梯”针对性抗感染治疗，辅以重症监测及液体管理，控制病情，稳定循环，并采取积极外科干预治疗，在病情出现反复时及时截除患肢，挽救患者生命。

Abstract: This paper reports a case of severe septic shock and necrotizing fasciitis (NF) of right upper limb caused by streptococcus pyogenes. Empirical antimicrobial therapy was initiated at the beginning and then shifted to target-oriented antibiotic treatment. Intensive monitoring and fluid balance control were applied in the ICU. When condition persists worse，surgical interventions were also instituted timely. After treatment， inflammatory index decreased significantly， vasoactive drugs rapidly tapered to discontinuation， and the patient was saved. to

罗理云,李烽辉,王颖菁,姚隽,彭环庆,唐钟祥,林辉文,陈海敏,曾昭上,刘炜枫,彭志允. 化脓性链球菌致脓毒症休克并右上肢坏死性筋膜炎1例报告[J]. .

luo liyun,LI Fenghui,WANG Yingjing,YAO Jun,PENG Huanqin,TANG Zhongxiang,LIN Huiwen,CHEN Haimin,ZENG Zhaoshang,LIU Weifeng and PEMG Zhiyun. Septic Shock and Necrotizing Fasciitis of Right Upper Limb Due to Streptococcus Pyogenes：a Case Report[J]. .

参考文献

[1]Andrew Rhodes,Laura E,Evans Waleed A,et al.Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock:2016[J]. Crit Care Med,2017,
45(3):486-552
[2]ST Lille,TT Sato,LH Engrav,et al.Necrotizing soft tissue infections: obstacles in
diagnosis[J].Journal of the American College of Surgeons,1996,182(1):7-11
[3]Eric J Kuncir,AretiTillou,Charles R St. et al. Necrotizing soft-tissue infections[J]. Emergency Medicine Clinics ofNorth America 2003,21(4):1075-1087
[4]Kao Lillian S,Lew Debbie F,Arab Samer N.et al. Local variations in the epidemiology, microbiology, and outcome of necrotizing soft-tissue infections: a multicenter study.[J]. American Journal of Surgery,2011,202(2):139-145
[5]Das DK，Baker MG，Venugopal K. Ｒisk factors，microbiological findings and outcomes of necrotizing fasciitis in New Zealand: a retrospective chart review[J]. BMC Infectious Diseases,2012,12(1):348
[6]Ulug M.The evaluation of microbiology and Fournier’s gangrene severity index in 27 patients[J].Int J Infect Dis,2009,13 (6) : e424-e430
[7]Eliott DC.Kufera JA,Myers RA.Necrotizing soft tissue infections.Risk factor for mortality and strategies for management[J].Ann of Surg,1996;224(5):672-683
[8]吴昕，马志强，于健春，康维明，叶欣，,闫超.坏死性筋膜炎的诊断和治疗[J].中国普外基础与临床杂志，2014，21(10)：1289-1291
[9]陈杰，夏军，王思群，魏亦兵.坏死性筋膜炎研究现状[J].国际骨科学杂志，2011，32(02)：96-98
[10]Futes-Morales A,Gutierrez-Castrellon P,Duran-Mckinster C,et al.Necrotizing fasciitis:
resport of 39 pediatric cases[J]. Archives of Dermatology,2002,138（7）:893-899
[11]FH Hoeffel,JC Hoeffel.Necrotisng fasciitis of a limb[J]. Journal of Bone and Joint Surg
British volume,2001:83(5):709-714
[12]王华，黄骧，钱伟强，刘杰，李少华.坏死性筋膜炎研究进展[J].中国矫形外杂志，2015，23(17):1594-1596
[13]Pachowsky M,Gusinde J,Klein A,et al.Negative pressure wound therapy to prevent seromas and treat surgical incisions after total hip arthroplasty[J]. International Orthopaedics,2012,
36(4) :719-722.
[14]Linner A. Clinical efficacy of polyspecific intravenous immunoglobu-lin therapy in patients with streptococcal toxic shock syndrome: a comparative observational study[J].Clin Infect Dis,2014,59(6) :851-857
[15] Humar D,Datta V ,Bast DJ,et al.Streptolysin S and necrotising infections produced by group G streptococcus[J].Lancet,2002?,?359?(9301)?:124-129

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