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摘要: 本文对海军军医大学第一附属医院收治的2例创伤弧菌原发性脓毒症患者的临床资料进行总结分析，并综述最新文献。2019年11月6日收治1例54岁男性患者，其进食淡水水产品后双下肢红肿、疼痛明显，出现瘀斑及血性水疱，入院后3 h急诊行筋膜切开减张术，术后各脏器功能衰竭，入院后24 h放弃治疗。2020年8月12日收治1例73岁男性患者，其进食海鲜后右下肢出现血性水疱，入院时呈休克状态，入院后3 h急诊手术探查并行右大腿截肢，6 d后残端行负压伤口疗法，入院后13 d家属放弃积极治疗，入院后15 d患者死亡。2例患者均未能第一时间诊断，病情进展迅速，出现坏死性筋膜炎及多器官功能衰竭，明确诊断后分别予筋膜切开减张和高位截肢，微生物培养结果均为创伤弧菌。虽最终均未救治成功，但早期截肢患者病程及部分指标均优于切开减张者。创伤弧菌分布广泛，淡水水产品中多次检出，致病途径模糊复杂，极易误诊，宜建立创伤弧菌脓毒症救治流程，尽早积极手术干预，筋膜切开和清创应彻底，合并出血性大疱者应早期截肢，术后采用综合措施提高患者存活率。Abstract: This article analyzed the medical records of two patients with Vibrio vulnificus primary sepsis who were admitted to the First Affiliated Hospital of Naval Medical University and reviewed the latest literature. On November 6, 2019, a 54-year-old male patient was admitted to the hospital. The patient's lower limbs were red, swollen, and painful with ecchymosis and hemorrhagic bullae after he ate freshwater products. The emergency fasciotomy was performed 3 h after admission, and the multiple organ failure occurred after operation. The patient was given up treatment 24 h after admission. On August 12, 2020, a 73-year-old male patient was admitted to the hospital. He was in shock state on admission and had hemorrhagic bullae on his right lower limb after he ate seafood. At 3 h post admission, he underwent emergency surgical exploration and amputation of right thigh. Six days later, he received negative pressure wound treatment on the stump. On the 13th day post admission, his families forgo the active treatment and he died 15 d after admission. The two cases were both failed to be diagnosed at the first time, and the disease progressed rapidly. Necrotizing fasciitis and multiple organ failure occurred. After the diagnosis was confirmed, timely fasciotomy and high amputation were performed respectively. The microbiological examinations both reported Vibrio vulnificus. Although the 2 cases were not cured successfully, the course of disease and some indexes of patient with early amputation were better than those of patients with fasciotomy. Vibrio vulnificus is widely distributed and frequently detected in fresh water products. The pathogenic pathway is fuzzy and complex, and it is easy to be misdiagnosed. It is necessary to establish the treatment process of Vibrio vulnificus sepsis. Early and aggressive surgical intervention should be carried out as soon as possible, fasciotomy and debridement should be thorough, and the patients with hemorrhagic bullae should be amputated early. Postoperative comprehensive measures are also important for improving the survival rate of patients.
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Key words:
- Vibrio vulnificus /
- Sepsis /
- Fasciitis, necrotizing
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1 例1患者创伤弧菌原发性脓毒症患者双下肢病变情况。1A.入院后1 h双小腿肿胀，可见皮下血性瘀斑、血性水疱形成，足背动脉消失；1B.双下肢筋膜切开减张术后7 h，可见筋膜肌肉无生机
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