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尿源性脓毒血症的诊治:附15例报告

Diagnosis and Treatment of Urosepsis:Fifteen Case Reports

  • 摘要: 目的: 总结尿源性脓毒血症的早期诊断及治疗经验,以进一步指导临床。 方法: 回顾分析上海交通大学医学院附属新华医院急诊重症监护室收治的15例尿源性脓毒血症患者的临床资料。 结果: 15例尿源性脓毒血症患者中,60岁以上11例(73.33%),女性14例(93.33%),首发症状多样化。中段尿细菌培养阳性13例,其中大肠杆菌10例(76.92%),阴沟肠杆菌1例(7.69%),肠球菌2例(15.39%)。尿源性脓毒血症患者的急性生理学与慢性健康状况评分Ⅱ与降钙素原水平呈正相关(r=0.728,P<0.01),与血小板水平呈负相关(r=-0.717,P<0.01)。手术介入组血小板水平明显低于药物治疗组,差异有统计学意义(P<0.05)。结论: 老年女性是尿源性脓毒血症的高发人群,首发症状多样化,革兰阴性杆菌是主要致病菌。降钙素原及血小板水平可有效评估尿源性脓毒血症患者的病情。

     

    Abstract: Objective: To summarize early diagnosis and treatment experience of urosepsis so as to guide clinical work further. Methods: The clinical data of 15 patients with urosepsis treated in EICU of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. Results: Among 15 patients with urosepsis,there were 11 cases aged over 60 (73.33%), 14 female cases(93.33%),and diversified initial symptoms.The results of mid-stream urine bacterial culture were positive in 13 cases, of which 10 cases were E.coli(76.92%), 1 case was Enterobacter cloacae(7.69%), 2 cases were Enterococcus(15.39%). Acute physiology and chronic health evaluation Ⅱ score was positively correlated with procalcitonin level(r=0.728,P<0.01),and negatively correlated with platelet level(r=-0.717,P<0.01).Platelet level in the surgical intervention group was significantly lower than that in drug treatment group,and the difference was statistically significant(P<0.05). Conclusions: Elderly women are at high risk of urosepsis. And the initial symptom is diversified, while Gram-negative bacilli are the main pathogens.The condition of patients with urosepsis can be effectively assessed by procalcitonin and platelet levels.

     

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