感染性休克合并肝内门静脉积气1例

Treatment experience of one case of septic shock combined with hepatic portal venous gas

肝门静脉积气是一种由于多种病因导致气体在门静脉及其分支内积聚而形成的影像学征象,临床上较为少见,诊断过程中常被误诊为胆管积气,且病死率高,常合并感染性休克。此例患者因腹痛、高热入住滨州医学院附属医院,合并基础疾病多,平素身体素质差,入院后根据患者症状、体征及相关实验室检查,诊断为肠梗阻、感染性休克、门静脉积气。其中完善腹部CT提示门静脉积气,完善血培养提示唾液乳杆菌。治疗上立即给予液体复苏,予以泰能抗感染、乌司他丁控制炎症反应、升白细胞、强心、稳定内环境等治疗,患者仍存在血压、心率不稳定,经抢救无效死亡。2日后患者血培养结果提示唾液乳杆菌感染。该诊断病例临床较为罕见,预后差,临床医师可通过CT诊断,迅速明确患者感染病因,从而为患者赢得治疗时间。

Hepatic portal venous gas is an imaging sign formed by the accumulation of gas in the portal vein and its branches due to a variety of causes,which is relatively rare in clinical practice.It is often misdiagnosed as pneumobilia in the diagnosis process and has a high mortality rate,often accompanied by septic shock.This patient was admitted to the Binzhou Medical University Hospital due to abdominal pain and high fever,with multiple underlying diseases and poor physical fitness.After a dmission,based on the patient’s symptoms,signs,and relevant laboratory tests,the diagnosis was intestinal obstruction,septic shock,and hepatic portal venous gas.Among them,complete abdominal CT indicated hepatic portal venous gas and complete blood culture indicated lactobacillus salivarius.In terms of treatment,fluid resuscitation was immediately administered,tienam was administered for infections,ulinastatin was administered to control inflammatory reactions,increase white blood cells,strengthen the heart,and stabilize the internal environment.The patient still had unstable blood pressure and heart rate and died after rescue.Two days l ater,the patient’s blood culture results indicated infection with lactobacillus salivarius.This diagnostic case is clinically rare and has a poor prognosis.Clinicians can quickly determine the cause of the patient’s infection through CT diagnosis,thereby winning treatment time for the patient.