局部肌内注射致腰背部及臀部气性坏疽一例报告

Local intramuscular injection caused gas gangrene in the lower back and buttocks: case report

报告1例因进行局部肌内注射导致腰背部及臀部气性坏疽的临床病例。男,43岁,因腰痛在当地私人诊所就诊,给予腰背部及臀部局部肌内注射封闭治疗,肌内注射5~6 h后腰痛加重,疼痛视觉模拟评分(visual analogue scale,VAS)为5分,伴发热;1天后,腰痛VAS评分8分,出现酱油色尿,伴发热。根据实验室检查以及临床表现出现多器官功能衰竭,影像学(CT)提示腰背部棘突旁及右侧臀部软组织出现大面积气体,伴椎旁及臀部肌肉坏死征象,初步诊断:腰背部及臀部感染,高度怀疑气性坏疽。根据病情进展,入院后急诊行腰背部及右臀部扩创术,术中细菌快速涂片报告革兰氏阳性粗大杆菌,厌氧菌培养提示产气荚膜梭菌,需氧菌培养结果未见任何细菌生长。根据病史、影像资料、术中判断、术后培养结果,临床诊断:气性坏疽。气性坏疽是临床特殊感染疾病,其发病率低,早期诊断困难,疾病进展快,死亡率高。肌内注射导致该疾病的发生,需要强调规范化无菌操作的重要性。

We reported a clinical caseof gas gangrene in the lower back and buttocks due to local intramuscular injection.A 43-year-old male was treated by local private clinic for low back pain.He underwent local intramuscular injection in his lower back and buttocks.5 or 6 hours after the treatment,he felt worsen of low back pain(VAS 5 points)with a fever.After one day of treatment,the lower back pain was even worse(VAS 8 points).And he had soy-sauce urine and a high fever.The results of laboratory examination and clinical manifestation suggested multiple organ failure within a short period of time.Imaging(CT)suggested large area of gas and muscle necrosis in the lower back and buttocks.Considering the progress of the disease,emergency surgery on lumbar back and right buttocks was performed after hospitalization.Rapid bacterial smear reported gram-positive coarse bacteria.Anaerobic culture suggested clostridium perfringens.Aerobic culture result did not show any bacterial growth.According to the clinical manifestation,imaging(CT),intraoperative judgment and postoperative anaerobic culture results,the clinical diagnosis was gas gangrene.Gas gangrene is a special infectious disease in clinic,which can be characterized by low morbidity,difficult early diagnosis,rapid disease progression and high mortality.Sinceintramuscular injection leaded to this disease in our case,the importance of standardized aseptic procedures should be emphasized.