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经皮引流救治肝脓肿过程中的感染性休克——文献综述与病例报告

Septic Shock in the Course of Liver Absces Rescued with Percutaneous Drainage - A Literature Review and Case Report.

作者信息

Snarska Jadwiga, Michalak Maciej, Masiulaniec Piotr, Jacyna Krzysztof, Zalewski Artur

出版信息

Pol Przegl Chir. 2016 Oct 1;88(5):282-286. doi: 10.1515/pjs-2016-0065.

Abstract

This study presented a septic shock occurring with striking speed during the percutaneous drainage of a large abscess of the liver in an 18-year-old female patient after an appendectomy performed 3 months earlier using the laparoscopic method because of its phlegmonous and gangraenosus inflammation. The post-operative course was complicated by increased suppuration in places after removal of the trocars. After including the intravenous antibiotic therapy and under the USG control, the percutaneous drainage of the abscess was performed. While withdrawing the guide of the drainage catheter set, the symptoms of septic shock occurred. The pharmacological treatment was applied with continuation of the antibiotic therapy till a negative result of microbiological tests was obtained and the normalization of life parameters. The patient was not qualified for treatment in the ICU. She was discharged in a generally good condition after 24 days of hospitalization. In the case of this patient, the drain covered with the content of the abscess may have contact with the adjacent tiny blood vessels, which may have contributed to the systemic inflammatory response syndrome that was linked with fast-developing sceptic shock.

摘要

本研究报告了一名18岁女性患者,在3个月前因阑尾蜂窝织炎和坏疽性炎症采用腹腔镜方法进行阑尾切除术后,肝脏出现一个大脓肿,在经皮引流该脓肿期间,败血症性休克以惊人的速度发生。术后病程因拔除套管针后局部化脓加重而复杂化。在采用静脉抗生素治疗并在超声引导下,对脓肿进行了经皮引流。在拔出引流导管套件的导丝时,出现了败血症性休克的症状。应用了药物治疗,继续进行抗生素治疗,直至微生物检测结果为阴性且生命参数恢复正常。该患者不符合入住重症监护病房治疗的条件。住院24天后,她以总体良好的状态出院。对于该患者,被脓肿内容物覆盖的引流管可能与相邻的微小血管接触,这可能导致了与快速发展的感染性休克相关的全身炎症反应综合征。

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