急性传染病休克的临床诊治与转归分析

The Diagnosis and Emergency Treatment of Patients with Acute Infectious Shock

目的:探讨急性传染病休克患者的诊治策略,提高救治成功率。方法:回顾分析急性传染病休克患者的人口学、流行病学、病因分类、传染病发生至休克出现时间、早期临床诊治与转归等情况,总结诊治经验。结果:本组68例急性传染病休克主要来自呼吸道、消化道传染病,细菌和病毒是休克发生的主要病原,分别占54.4%和30.9%,仅25%的病例病前有明确的传染病接触史。51.9%的患者存在误诊误治现象。在明确休克发生病理机制的前提下,早期快速有效的抗休克、抗感染治疗,短期使用糖皮质激素,积极纠正酸碱、电解质紊乱,并给予必要的对症支持治疗,治愈出院率92.6%,平均康复住院时间3～11天,平均(5.8±2.4)天。结论:急性传染病休克早期误诊现象突出;给予积极抗休克、抗感染、激素治疗,纠正酸碱和电解质紊乱,结合对症支持治疗,可在短期内治愈患者。

Objective：To explore the strategy of diagnosis and treatment of shock in patients with acute infectious diseases,improve the rescue success rate.Methods：The clinical data,including demographic,epidemiology,etiology,the period of infectious diseases oc-currence to the shock appearance,early clinical diagnosis and treatment,and outcome,of 68 patients with acute infectious diseases were analysed.Results：The group of 68 cases of acute infectious diseases shock were mainly from the respiratory tract,gastrointestinal dis-eases.Bacteria and viruses were the main pathogens of the shock,which accounted for 54.4% and 30.9%,respectively.Only 25% of cas-es had a clear history of exposure of infectious diseases before.51.9% of patients had been misdiagnosed.On the basis of a clear patho-genesis of shock,early fast and effective anti-shock,anti-infective therapy,short-term use of corticosteroids,and actively correct the pH,electrolyte imbalance,and necessary support for symptomatic treatment were given.The cured rate was 92.6% and the rehabilitation length of stay was 3 to 11 days,the average（5.8 ±2.4） days.Conclusion：Misdiagnosed phenomenon highlights the acute infectious stage of shock.With positive anti-shock,anti-infective,hormone therapy,correcting acid-base and electrolyte imbalance,combined with symptomatic and supportive treatment,the patients can be cured in a short term.