大面积烧伤患者非典型脓毒症休克合并急性肺水肿一例

One case of atypical septic shock with acute pulmonary edema in a patient with extensive burn

2018年10月16日,海军军医大学第一附属医院收治1例因工业粉尘爆燃致大面积烧伤的25岁男性。首次植皮+负压封闭引流术后4 d,患者出现了剧烈失控的炎症反应和休克征象,但若干非典型的表现对脓毒症休克的诊断产生了干扰。给予补液、广谱抗生素、血管活性药物等抢救措施后,患者病情短暂缓解,但很快复发恶化,并于当日晚间出现了急性肺水肿。最后,通过拆除双上肢负压装置并彻底换药,使病情得到了逆转。这提示大面积烧伤患者的感染诊治,需要综合分析判断,及时干预创面是遏制脓毒症加剧的关键,此外应高度警惕脓毒症患者出现肺水肿的可能。

A 25-year-old man with extensive burn due to industrial dust explosion was admitted to the First Affiliated Hospital of Naval Medical University on 16th October,2018.Four days after the first skin grafting and vacuum sealing drainage surgery,the patient developed signs of uncontrolled severe inflammation and shock.However,several atypical manifestations interfered the diagnosis of septic shock.After giving emergency treatment including fluid resuscitation,broad-spectrum antibiotics,and administration of vasopressor agents,the patient′s condition was alleviated,but quickly relapsed and deteriorated,with acute pulmonary edema appeared in the evening of the same day.Finally,the condition was reversed by completely removing the negative pressure devices on upper limbs and thorough dressing change.This case suggests that the diagnosis and treatment of infection in patients with extensive burn need comprehensive analysis.Timely intervention of the wound is the key to control the exacerbation of sepsis.In addition,the possibility of pulmonary edema in patients with sepsis should be on high alert.