一组原因不明脓毒症病例分析

Analysis on a group of unexplained sepsis

目的探讨一组原因不明脓毒症病例的病因,以引起对该类疾病的重视,提高认识并寻找有效治疗方法。方法回顾性调查本院连续4年发生的不明原因脓毒症患者,对资料完整的40例进行临床分析,对诊断及治疗进行回顾性分析。结果患者多发于春夏之交,均表现为白细胞和血小板减低,伴不同程度多脏器功能损害。反复细菌培养阴性,不支持细菌感染,已知的病毒及立克次体血清学检查均阴性,病因不明。该组病例具有急性起病、病情进展迅速、治疗不及时、病死率高等特点。结论本组病例诊断符合脓毒症,多次会诊认为不能除外人粒细胞无形体病,治疗主要为对症及支持治疗,同时抗生素、抗病毒药物,重症患者短期应用糖皮质激素,未发现人与人交叉感染。

Objective To investigate the reasons of a group of unexplained sepsis and enhance the understanding of the diseases and seek the effective treatment measures. Methods Unexplained sepsis pa- tients in our hospital for 4 years were reviewed retrospectively, 40 patients were enrolled and clinical data were investigated. Results All 40 patients were demonstrated with leukopenia and thrombocytopenia which accompanied with varied degrees of multiple organ functional disorder, but bacterial culture, viruses and ri- chettsia serology tests were negative. This disease progressed rapidly with acute onset and high mortality if not treated early. Conclusions These patients may be diagnosed as sepsis of unexplained reasons. The hu- man granulocytic anaplasmosis may be the reason but can not be proved due to limited conditions. Therapies included support treatments, antibiotics, anti-virus and symptomatic treatments. In severe cases, glucocorti- coids was used in short time. No cross-infection from person to person was found.