1例暴发型流行性脑脊髓膜炎(休克型)患者的诊疗分析

Analysis of Diagnosis and Treatment of One Patient with Fulminant Epidemic Cerebrospinal Meningitis (Shock Type)

目的:分析暴发型流行性脑脊髓膜炎(休克型)患者的临床特点和诊疗过程,为该类患者的临床救治提供参考。方法:患者2021年1月5日病发后送至苏州大学附属第一医院救治,其间血液和脑脊液标本的高通量测序检查结果均提示脑膜炎奈瑟菌,遂明确“暴发型流行性脑脊髓膜炎(休克型)”诊断,后转诊至苏州市第五人民医院重症医学科治疗。结果:患者在两家医院的积极救治下,未再检出脑膜炎奈瑟菌,但由于疾病进展过快,已严重损伤四肢和脏器,且呼吸存在呼吸机依赖,故其家属未再同意继续治疗。结论:暴发型流行性脑脊髓膜炎(休克型)起病急骤、病情凶险,严重考验临床第一时间的鉴别和诊断能力,急诊和重症科室尤其应当注重对该疾病相关知识的学习和培训,提升临床应对能力,最终提高患者的救治成功率。

Objective: To analyze the clinical characteristics and diagnosis and treatment process of one patient with fulminant epidemic cerebrospinal meningitis(shock type), so as to provide reference for the clinical treatment of such patients. Methods: The patient was sent to the First Affiliated Hospital of Soochow University after the onset of illness on January 5, 2021. During the period, the results of high-throughput sequencing tests of blood and cerebrospinal fluid samples showed Neisseria meningitidis, and the patient was diagnosed with fulminant epidemic cerebrospinal meningitis(shock type), then transferred to Department of Critical Care Medicine, Suzhou Fifth People’s Hospital.Results: Under the active treatment of two hospitals, Neisseria meningitidis was no longer detected. However, the patient’s limbs and organs were severely damaged and the breathing required the assistance of ventilator due to too rapid disease progression, so the family members disagreed to continual treatment. Conclusion: The fulminant epidemic cerebrospinal meningitis(shock type) has a rapid onset and serious disease condition, which seriously challenges the clinical identification and diagnosis as quickly as possible. The Emergency Department and ICU should pay special attention to the study and training of relevant disease knowledge, improve the clinical management ability, and ultimately increase the treatment success rate of patients.