Tourrel F, Gouin P, Dureuil B, Veber B
Département d'anesthésie-réanimation chirurgicale et Samu, CHU, 1, rue de Germont, 76031 Rouen cedex, France.
Ann Fr Anesth Reanim. 2007 Oct;26(10):869-72. doi: 10.1016/j.annfar.2007.07.079. Epub 2007 Sep 4.
About fifty to sixty percent of patients with septic shock acquire acute adrenal insufficiency. This insufficiency is most often relative, but can sometimes be absolute. Bilateral adrenal haemorrhage is a rare aetiology of absolute acute adrenal insufficiency. It is classically described in patients with severe meningococcemia (purpura fulminans), who commonly present many of the risk factors associated with bilateral adrenal haemorrhage (shock, coagulation disorders, sepsis). We report a case of bilateral adrenal haemorrhage during a peritonitis complicated by a septic shock, with no coagulation disorder. This observation shows up that this bilateral adrenal haemorrhage can complicate severe sepsis of various origins, and not only severe meningococcemia. It can be suspected in face of a septic shock with an unfavourable evolution despite adequate treatment.
约50%至60%的感染性休克患者会出现急性肾上腺功能不全。这种功能不全大多是相对性的，但有时也可能是绝对性的。双侧肾上腺出血是绝对性急性肾上腺功能不全的一种罕见病因。典型的情况见于严重脑膜炎球菌血症（暴发性紫癜）患者，这类患者通常存在许多与双侧肾上腺出血相关的危险因素（休克、凝血障碍、败血症）。我们报告一例在腹膜炎并发感染性休克期间发生双侧肾上腺出血的病例，该患者并无凝血障碍。这一病例表明，这种双侧肾上腺出血可使各种病因的严重脓毒症复杂化，而不仅限于严重脑膜炎球菌血症。面对经适当治疗但病情仍进展不利的感染性休克时，应怀疑存在这种情况。
