非月经相关性中毒性休克综合征的诊治临床分析

Diagnosis and treatment of nonmenstrual toxic shock syndrome

报告１２例非月经相关性中毒性休克综合征（ＴＳＳ）。感染灶依次为粘膜、皮下组织感染、输液反应及呼吸道感染。临床表现较典型：猩红热样皮疹、吐泻等常为一过性，而低血压、直立性晕厥、肌痛等常延续数天；多系统器官受累症状出现早，受累频率依次为肌肉、粘膜、血小板、肾脏、中枢神经系统、心脏、胃肠道及肺脏；血白细胞及中性粒细胞显著增高。全病程误诊的４例中３例死亡，入院后确诊ＴＳＳ８例痊愈。提示：能否及时诊治与预后好坏关系密切，ＴＳＳ的治疗措施主要是积极抗休克和及时使用耐β内酰胺酶抗生素。

Nonmenstrual toxic shock syndrome(TSS)has been reported with increasing frequency in recent years.We found 12 patients from our department who had nonmenstrual TSS from July 1982 to June 1994.The foci of infection were infection of membrane,infection of subcutaneous tissue,reaction to fluid infusion,and respiratory infection successively.The clinical manifestations were typical.Scarletiniform rash,vomiting and diarrhea were usually transient.Hypotension.orthostatic syncope and myalgia often lasted a few days.Multiple system organ failure appeared early.The frequency of organ involvement were muscle,mucosa,platelets,kidneys,central nervous system,heart,gastrointestinal tract and lungs successively.White blood cells and neutrophiles were markedly increased.Of the 12 patients,eight were cured and four were misdiagnosed.Among the four misdiagnosed patients,three died.It is suggested that timely diagnosis and treatment is closely related to the prognosis.prompt administration of antishock agents and βlactamaseresistant antibiotics is the main treatment of TSS.