12例发热伴血小板减少综合征并发自发性腹壁血肿患者临床特征分析

Analysis of clinical characteristics of 12 patients with severe fever with thrombocytopenia syndrome complicated with spontaneous abdominal wall hematoma

目的分析12例发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)并发自发性腹壁血肿(spontaneous abdominal wall hematoma,SAWH)患者的临床特征、诊疗经过及预后,提高临床医生对SFTS并发SAWH的认识。方法收集2011年3月—2021年11月联勤保障部队第990医院信阳医疗区感染科收治的12例SFTS并发SAWH患者的临床资料和随访结果,并进行相关统计学分析。结果12例患者中,男性2例,女性10例,平均年龄65.8岁,发病时间集中在5~10月,临床表现主要为发热,乏力,明显食欲减退,恶心、呕吐,腹部持续性疼痛,皮下淤血、瘀斑,血红蛋白进行性下降。12例患者中SFTS普通型2例、重型7例、危重型3例。SAWH确诊时间均在SFTS病程的7~13d,其中发生在极期8例、恢复期4例。12例患者中并发肺部感染10例,SAWH均发生在肺部感染后3~5 d。10例患者好转出院,2例患者死亡。结论SAWH是SFTS少见并发症,多发生在重型和危重型患者的极期或恢复期,以腹部持续性疼痛,皮下淤血、瘀斑,HGB进行性下降为突出表现,及时CT检查可早期诊断,经内科综合治疗,总体预后良好。

Objective To analyze the clinical characteristics,diagnosis and treatment and prognosis of 12 patients with severe fever with thrombocytopenia syndrome(SFTS)complicated with spontaneous abdominal wall hematoma(SAWH),and to improve clinicians’understanding of disease.Method From March 2011 to November 2021,the clinical data and follow-up results of 12 patients with SFTS complicated with SAWH admitted to Xinyang Medical District,990 Hospital of Joint Logistic Support Force were collected and statistically analyzed.Results There were 2 males and 10 females.The average age was 65.8 years.The onset was concentrated between May and October.The clinical manifestations of this disease were fever,fatigue,apparent anorexia,nausea and vomiting,persistent abdominal pain,subcutaneous congestion and ecchymosis,and progressive decrease in HGB.Among the 12 patients,there were 2 cases of SFTS common type,7 cases of severe type and 3 cases of critical type.SAWH was diagnosed in 12 cases within 7~13 days of the course of SFTS,with 8 cases in the polar phase and 4 cases in the convalescent phase.Ten cases complicated with pulmonary infection,and SAWH occurred 3~5 days after pulmonary infection.Finally,10 patients recovered and were discharged,and 2 patients died.Conclusions SAWH is a rare complication of SFTS,which usually occurs in the late extreme phase or convalescent phase of patients with severe and critically type.The main and prominent manifestations are persistent abdominal pain,subcutaneous congestion and ecchymosis,with progressive decrease in HGB.Timely CT examination can be helpful to early diagnosis.The overall prognosis is good by medical comprehensive treatment.