新型人工肝成功救治1例斑疹伤寒继发多器官功能障碍综合征

A case of multiple organ dysfunction syndrome secondary to typhus was successfully treated with the new artificial liver

目的探讨新型人工肝,即血浆置换(plasma exchange,PE)+双重血浆分子吸附系统(double plasma molecular adsorption system,DPMAS)+连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)在救治斑疹伤寒继发多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)的应用价值。方法回顾性报道新型人工肝(PE+DPMAS+CRRT)成功救治1例斑疹伤寒继发MODS的诊治经过并总结经验。结果患者为36岁男性,因“发热3 d,伴皮肤黄染1 d,意识障碍6 h”入院,经查体、血常规、降钙素原、白细胞介素-6、肝肾功能、凝血功能、血液基因二代测序(mNGS)、胸部CT等检查,诊断为:(1)斑疹伤寒;(2)脓毒症;(3)MODS(肝、肾、中枢、血液、呼吸);(4)肺部感染等。在内科综合治疗效果欠佳的基础上,联合新型人工肝(PE+DPMAS+CRRT)治疗,患者的感染指标及肝肾功能等脏器功能指标均明显好转,最终康复出院。结论斑疹伤寒继发MODS的患者应在内科综合治疗基础上尽快联合新型人工肝(PE+DPMAS+CRRT)治疗。

Objective To investigate the application value of new artificial liver(plasma exchange(PE)+double plasma molecular adsorption system(DPMAS)+continuous renal replacement therapy(CRRT))in the treatment of multiple organ dysfunction syndrome(MODS)secondary to typhus.Methods A case of MODS secondary to typhus treated by PE+DPMAS+CRRT in Hainan Hospital Affiliated to Hainan Medical College was retrospectively reported and the experience was summarized.Results The patient was a 36-year-old male who was admitted to the hospital with fever for 3 days,skin yellow staining for 1 day and consciousness disturbance for 6 hours.After physical examination,blood routine examination,procalcitonin,interleukin-6,liver and kidney function,coagulation function,blood gene sequencing(mNGS)and chest CT,the patient was diagnosed as:(1)Typhus,(2)Sepsis,(3)MODS(liver,kidney,central,blood,respiratory),etc.On the basis of poor effect of comprehensive medical treatment,combined with the new artificial liver(PE+DPMAS+CRRT)treatment,the patient's infection indicators and organ function indicators such as liver and kidney function were significantly improved,and finally recovered and discharged.Conclusions Patients with MODS secondary to typhus should be treated timely with new artificial liver(PE+DPMAS+CRRT)on the basis of comprehensive medical treatment.