Keese Michael, Nichterlein Thomas, Hahn Matthias, Magdeburg Richard, Karaorman Mevlut, Back Walter, Sturm Jörg, Kerger Heinz
Department of Surgery, University Hospital of Mannheim, 68135 Mannheim, Germany.
Resuscitation. 2003 Aug;58(2):219-25. doi: 10.1016/s0300-9572(03)00121-7.
We report a case of sudden death after gas gangrene. A 67-year-old male patient with diabetes mellitus and chronic renal failure (on haemodialysis three times a week) presented in the surgical emergency department with a severe swelling and crepitation in the right groin. No signs of trauma were present-except for a well-healed, 1-year-old scar after femoro-popliteal bypass surgery. Two days earlier, he had presented to the internal medicine department with epigastric pain and had left against medical advice. On readmission the patient was initially conscious and in a stable cardiopulmonary condition but developed sudden cardiocirculatory failure and underwent resuscitation. Despite all resuscitation measures, including the administration of high doses of catecholamines and the treatment of hyperkalemia, the patient died. Autopsy revealed septicaemia with rod-shaped gram-positive bacteria, typical of Clostridium perfringens, evidenced by multiple areas of myonecrosis. Abscess formation was found in the myocardium. Clostridial gas gangrene is a rare clinical condition. Unless immediate diagnosis and adequate therapy measures are taken, the outcome and chances for survival are poor as demonstrated by this case.
我们报告一例气性坏疽后猝死的病例。一名67岁男性患者，患有糖尿病和慢性肾衰竭（每周接受三次血液透析），因右腹股沟严重肿胀和捻发音就诊于外科急诊科。除了股腘动脉搭桥手术后有一个愈合良好的1年陈旧瘢痕外，无外伤迹象。两天前，他因上腹部疼痛就诊于内科，之后自行离院，未遵循医嘱。再次入院时，患者最初意识清醒，心肺状况稳定，但随后突然发生心循环衰竭并接受了复苏治疗。尽管采取了所有复苏措施，包括给予大剂量儿茶酚胺和治疗高钾血症，患者仍死亡。尸检显示存在败血症，有革兰氏阳性杆菌，为产气荚膜梭菌典型表现，多处肌肉坏死可证实。心肌中发现有脓肿形成。梭菌性气性坏疽是一种罕见的临床病症。如本病例所示，除非立即做出诊断并采取适当的治疗措施，否则预后及生存几率都很差。
