Strohmaier W, Mauritz W, Gaudernak T, Grünwald C, Schüller W, Schlag G
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.
Circ Shock. 1992 Dec;38(4):219-21.
We describe a case of a 38-year-old female accident victim who was admitted to the trauma hospital with an ISS of 66. Successful emergency treatment (including amputation of the left leg) and 4 weeks of intensive care led to an overall improvement so that the patient was extubated on day 29. Throughout this period neopterin was measured routinely 3 times a week and correlated well with the clinical course. At the end of the fifth week massive lung impairment and all clinical signs of sepsis appeared. Neopterin values increased dramatically up to 200 nmol/L. However, no abnormal findings were revealed by X-ray, contrast fluoroscopy, or sonographic imaging. To examine the amputation site more closely, simultaneous determination of neopterin in samples from the vena and arteria femoralis was performed. We found a 50% higher level in the venous blood (300 vs. 200 nmol/L). This was regarded as evidence for a hidden focus. Immediate surgical intervention revealed an abscess, which proved to be Pseudomonas aeruginosa positive. After adequate treatment the patient recovered quickly. In this case neopterin was not only helpful in monitoring the septic episodes of the patient, but proved essential for the detection of a septic focus and the risk of explorative relaparotomy could be omitted.
我们描述了一例38岁女性事故受害者，她因损伤严重度评分（ISS）为66被收入创伤医院。成功的急诊治疗（包括左腿截肢）和4周的重症监护使病情总体改善，患者于第29天拔管。在此期间，每周常规检测3次新蝶呤，其结果与临床病程密切相关。在第五周结束时，出现了严重的肺功能损害和脓毒症的所有临床体征。新蝶呤值急剧上升至200 nmol/L。然而，X线、造影透视或超声成像均未发现异常。为了更仔细地检查截肢部位，同时测定了股静脉和股动脉样本中的新蝶呤。我们发现静脉血中的水平高出50%（300 vs. 200 nmol/L）。这被视为存在隐匿病灶的证据。立即进行的手术干预发现了一个脓肿，结果显示为铜绿假单胞菌阳性。经过适当治疗，患者很快康复。在这个病例中，新蝶呤不仅有助于监测患者的脓毒症发作，而且被证明对于发现脓毒症病灶至关重要，从而可以避免进行探索性再次剖腹手术的风险。
