化脓性链球菌感染致成人急性感染性暴发性紫癜的治疗及文献回顾

doi:10.3969/j.issn.1002-1949.2019.05.016

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摘要目的探讨化脓性链球菌感染致急性感染性暴发性紫癜（AIPF）的临床症状、体征及辅助检查指标变化，为此疾病的诊断与治疗提供参考。方法回顾本科2016年7月3日收治1例患者的病历、临床表现、体征、实验室检查结果及诊治经过，结合数据库中以“暴发性紫癜”与“化脓性链球菌”及“fulminant purpura”与“Streptococcus pyogenes”检索获得的2个相似病例，分析比较其临床特征及治疗过程，探讨可能的诊疗防治措施。结果 ①化脓性链球菌感染致AIPF可能是一类好发于中老年人的特殊暴发性紫瘢（PF）亚型；②疾病进展极快，存在严重全身炎性反应，降钙素原（PCT）、C反应蛋白（CRP）等显著升高，炎性细胞减少，早期易发生感染性休克；③血小板进行性减少，凝血功能障碍，D-二聚体升高；④感染可通过血液及局部扩散导致感染扩散；⑤可致肝、肾、心、肺功能衰竭（MODS）并存在电解质紊乱，酸碱平衡紊乱；⑥肌红蛋白（Mb）、肌酸激酶(CK)及其同工酶(CK-MB)显著升高（肌肉等组织溶解反应）。结论化脓性链球菌急性感染抗感染治疗效果不佳，预后差，致死率高，国内尚无治愈病例，可手术患者尽早手术可能有效。

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	王本超
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关键词 ：暴发性紫癜（PF）, 化脓性链球菌, 急性感染, 感染性休克

通讯作者: 彭昊（1963-），男，博士，E-mail:penghao5868@163.com。

作者简介: 王本超（1993-），男，硕士，E-mail:chuck101@163.com。

引用本文:

王本超，金林鑫，陈森，彭昊. 化脓性链球菌感染致成人急性感染性暴发性紫癜的治疗及文献回顾[J]. 中国急救医学, 2019, 39(5): 476-479.
Wang Ben-chao, Jin Lin-xin, Chen Sen, Peng Hao. Acute infectious purpura fulminans caused by Streptococcus pyogenes: treatment and literature review. Chinese Journal of Critical Care Medicine, 2019, 39(5): 476-479.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2019.05.016 或 http://www.cnemergency.org.cn/CN/Y2019/V39/I5/476

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