16例非伤寒沙门菌感染性主动脉瘤患者的临床分析

Clinical analysis of 16 cases of infectious aortic aneurysms caused by nontyphoidal Salmonella

目的探索非伤寒沙门菌感染性主动脉瘤患者的临床特征,治疗及转归。方法收集医院2007年1月-2016年12月非伤寒沙门菌感染性主动脉瘤患者的基本特征、临床表现、疾病诊治以及临床结局等信息。结果 16例非伤寒沙门菌感染性主动脉瘤患者中,男15例,女1例,平均年龄(64.5±16.26)岁,多合并有高血压、糖尿病等基础疾病;主要症状为发热或局部疼痛;影像学提示多为假性动脉瘤,位置多在肾动脉以下;病原体以都柏林沙门菌和猪霍乱沙门菌为主,对氨苄西林及氨苄西林/舒巴坦耐药;入院3日内手术8例,抗感染后限期手术6例,治疗中出现动脉瘤破裂征象急诊手术1例,病情平稳、发病后多年手术1例;均予腔内修复术,即刻成功率100.00%;规则随访,9例疗效满意;3例死亡;3例局部脓肿形成,其中2例抗感染同时经外科治疗后好转,1例患者拒绝外科治疗、单纯内科治疗好转后失访;1例患者术后出院后失访。结论非伤寒沙门菌感染性主动脉瘤常发病于有基础疾病的老年人,症状相对不特异,病情凶险,微生物学检查和必要的血管影像学检查意义重大,恰当的抗感染治疗加上适时手术是治疗该病的基本原则。

OBJECTIVE To explore the clinical characteristics,treatments and outcomes of patients with infectious aortic aneurysms caused by nontyphoidal Salmonella （NTS）.METHODS Patients with infectious aortic aneurysm caused by NTS were enrolled in our hospital from Jan.2007 to Dec.2016,and their basic characteristics,clinical manifestations,diagnosis,treatments,and clinical outcomes were collected.RESULTS Among 16 cases of infectious aneurysm caused by NTS,15 were males and 1 was female,their average age was 64.5＆#177;16.26 years old,and most of them were complicated with hypertension,diabetes or other diseases.The main symptom was fever or local pain;angiographic examinations suggested that most were pseudo-aneurysm,and most were below the renal artery level.The main pathogens were Salmonella Dublin and Salmonella Cholerae,which were always resistant to ampicillin and ampicillin/sulbactam.There were 8 cases with surgeries in 3 days after admission,and 6 cases with deadline surgeries after antibiotic treatments.There was 1 case of emergency surgery with rupture signs during antibiotic treatment,and 1 case with stable condition and then a surgery years after the onset.All 16 patients underwent endovascular repair,with the immediate success rate of 100%.During the regular follow-up period,9 patients were alive and well with no signs of persistent or recurrent infection,3 patients died,3 patients had local abscess formation,among which 2 patients were cured by surgical measures and the one left relieved by simple medical treatment and then lost,and 1 patient was lost to follow-up after postoperative discharge.CONCLUSION Infectious aortic aneurysm caused by NTS is often found in the elderly with underlying diseases,with nonspecific symptoms and dangerous conditions.Microbiological and necessary angiographic examinations are of great significance,and appropriate anti-infection and timely surgeries are the basic principles of treatment.