BACKGROUND Visceral disseminated varicella-zoster virus(VZV)infection is a rare but lifethreatening disease.In transplant recipients with VZV infection,visceral dissemination may develop without skin eruptions,which l...BACKGROUND Visceral disseminated varicella-zoster virus(VZV)infection is a rare but lifethreatening disease.In transplant recipients with VZV infection,visceral dissemination may develop without skin eruptions,which leads to the failure of early diagnosis.CASE SUMMARY The patient was a 33-year-old male renal recipient who was referred to our hospital with severe upper abdominal pain of 3-d duration.On admission,the patient rapidly developed septic shock and multiple organ dysfunction syndrome with liver dysfunction and acute kidney injury.Next-generation sequencing of peripheral blood yielded 39224 sequence reads of VZV,and real-time polymerase chain reaction for VZV was positive,with 1.2×10^(7) copies/mL.The final diagnosis was visceral disseminated VZV infection.Acyclovir and supportive therapy were started,but the patient died of severe visceral organ damage 16 h after admission.CONCLUSION Visceral disseminated VZV infection is possible in renal transplant recipients presenting abdominal pain and rapidly-evolving organ damage without skin involvement.展开更多
Systemic inflammatory response syndrome (SIRS) and its lethal sequela multiple organ dysfunction syndrome (MODS) are common complications in critical illness, such as severe trauma, shock, infection and major operatio...Systemic inflammatory response syndrome (SIRS) and its lethal sequela multiple organ dysfunction syndrome (MODS) are common complications in critical illness, such as severe trauma, shock, infection and major operations. During the past three decades, the evolution in our understanding of SIRS and/or MODS could be divided into three stages. Particularly in recent years, advances in molecular and cellular biology have provided new insights in the pathogenesis of this complex condition. The earlier emphasis on the pro inflammatory mediators involved in propagation of inflammatory response, has gradually been replaced by a realization that SIRS/MODS are the result of an imbalance of pro and anti inflammatory mediators to create the final status of excessive inflammation or immunoparalysis’. Though prognosis remains poor, the knowledge that now exists about SIRS/MODS gives great hope for the future. Progress has been made in new treatment modalities and re evaluation of current available measures. Nevertheless, improved techniques to monitor immunological or other markers of inflammatory and host defense responses will be important in assessing the effects of future therapies on central mechanisms contributing to SIRS/MODS.展开更多
目的综合分析肺部感染诱发老年多器官功能不全综合征(multiple organ dysfunction syndrome in the elderly,MODSE)的临床特点。方法回顾性综合分析我院老年科64例因肺部感染诱发MODSE患者的临床特点、影像和实验室资料、APACHEⅡ评分...目的综合分析肺部感染诱发老年多器官功能不全综合征(multiple organ dysfunction syndrome in the elderly,MODSE)的临床特点。方法回顾性综合分析我院老年科64例因肺部感染诱发MODSE患者的临床特点、影像和实验室资料、APACHEⅡ评分变化等情况。结果 64例因肺部感染诱发MODSE患者均存在≥3种基础疾病,以脑血管疾病最多,占70.3%(45/64)。全部肺部感染病原体以耐药铜绿假单胞菌54.7%(35/64)、金黄色葡萄球菌28.1%(18/64)为多见。好转41例(64.1%),死亡23例(35.9%),其中2个器官功能衰竭者死亡3例(13.1%,2/23),3个器官功能衰竭者死亡18例(72.3%,18/23),≥4个以上器官功能衰竭者2例全部死亡。存活患者APACHEⅡ评分明显低于死亡患者。结论肺部感染是诱发MODSE主要诱因之一,基础疾病、受累器官越多,APACHEⅡ评分高,抗菌药物初始治疗不合理者,病死率越高。早期、合理使用抗菌药物治疗,对肺部感染诱发的MODSE具有重要临床价值。展开更多
目的探讨血必净、酚妥拉明、多巴胺联合治疗慢性阻塞性肺疾病急性加重期(AECOPD)并发多脏器功能衰竭的临床效果。方法选取2011年7月至2014年7月河北省民政总医院收治的AECOPD并发多脏器功能衰竭患者150例,按照随机数字表法分为对照组、...目的探讨血必净、酚妥拉明、多巴胺联合治疗慢性阻塞性肺疾病急性加重期(AECOPD)并发多脏器功能衰竭的临床效果。方法选取2011年7月至2014年7月河北省民政总医院收治的AECOPD并发多脏器功能衰竭患者150例,按照随机数字表法分为对照组、观察A组和观察B组,每组50例。患者均接受常规治疗,观察A组在常规治疗的基础上加用5%葡萄糖200 m L+酚妥拉明10 mg+多巴胺20 mg,静脉滴注;观察B组在常规治疗基础上,加用血必净100 m L每日2次静脉滴注,联合5%葡萄糖200 m L+酚妥拉明(10 mg)+多巴胺(20 mg),静脉滴注。治疗周期为15 d。比较三组的临床疗效及治疗前后炎症指标[外周血白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)],凝血功能指标[血浆D-二聚体、血小板计数(PLT)、纤维蛋白原(Fib)]及心功能指标[左心室射血分数(LVEF)]。结果对照组、观察A组和观察B组总有效率分别为42.0%(21/50)、62.0%(31/50)和80.0%(40/50),三组临床疗效比较差异有统计学意义(P<0.05),且观察B组总有效率高于对照组和观察A组(P<0.05)。治疗后观察B组患者WBC、CRP及PCT水平分别为(10.0±3.1)×109/L、(20±6)mg/L、(0.23±0.11)μg/L,且显著低于对照组[(17.2±5.8)×109/L、(61±8)mg/L、(0.71±0.19)μg/L]和观察A组[(17.6±2.2)×109/L、(61±9)mg/L、(0.69±0.27)μg/L],差异均有统计学意义(P<0.05)。治疗后三组患者PLT和LVEF水平显著上升,Fib及D-二聚体水平均显著下降;观察A组PLT和LVEF水平为(160±45)×109/L、(57±5%),观察B组分别为(201±50)×109/L、(61±5)%,均显著高于对照组[(138±36)×109/L、(54±4)%],且观察B组显著高于观察A组,差异有统计学意义(P<0.05);观察A组Fib、D-二聚体水平为(3.9±0.9)g/L、(1.2±0.8)mg/L,观察B组分别为(3.2±1.0)g/L、(0.7±0.2)mg/L,均显著低于对照组[(4.4±0.9)g/L、(1.6±0.6)mg/L],且观察B组显著低于观察A组,差异有统计学意义(P<0.05)。结论常规治疗基础上,加用血必净+酚妥拉明+多巴胺治疗AECOPD并发多脏器功能衰竭,能快速有效地改善患者炎症、凝血功能及心脏功能,疗效显著,优于单用酚妥拉明+多巴胺联合常规疗法,值得推荐。展开更多
文摘BACKGROUND Visceral disseminated varicella-zoster virus(VZV)infection is a rare but lifethreatening disease.In transplant recipients with VZV infection,visceral dissemination may develop without skin eruptions,which leads to the failure of early diagnosis.CASE SUMMARY The patient was a 33-year-old male renal recipient who was referred to our hospital with severe upper abdominal pain of 3-d duration.On admission,the patient rapidly developed septic shock and multiple organ dysfunction syndrome with liver dysfunction and acute kidney injury.Next-generation sequencing of peripheral blood yielded 39224 sequence reads of VZV,and real-time polymerase chain reaction for VZV was positive,with 1.2×10^(7) copies/mL.The final diagnosis was visceral disseminated VZV infection.Acyclovir and supportive therapy were started,but the patient died of severe visceral organ damage 16 h after admission.CONCLUSION Visceral disseminated VZV infection is possible in renal transplant recipients presenting abdominal pain and rapidly-evolving organ damage without skin involvement.
文摘Systemic inflammatory response syndrome (SIRS) and its lethal sequela multiple organ dysfunction syndrome (MODS) are common complications in critical illness, such as severe trauma, shock, infection and major operations. During the past three decades, the evolution in our understanding of SIRS and/or MODS could be divided into three stages. Particularly in recent years, advances in molecular and cellular biology have provided new insights in the pathogenesis of this complex condition. The earlier emphasis on the pro inflammatory mediators involved in propagation of inflammatory response, has gradually been replaced by a realization that SIRS/MODS are the result of an imbalance of pro and anti inflammatory mediators to create the final status of excessive inflammation or immunoparalysis’. Though prognosis remains poor, the knowledge that now exists about SIRS/MODS gives great hope for the future. Progress has been made in new treatment modalities and re evaluation of current available measures. Nevertheless, improved techniques to monitor immunological or other markers of inflammatory and host defense responses will be important in assessing the effects of future therapies on central mechanisms contributing to SIRS/MODS.
文摘目的综合分析肺部感染诱发老年多器官功能不全综合征(multiple organ dysfunction syndrome in the elderly,MODSE)的临床特点。方法回顾性综合分析我院老年科64例因肺部感染诱发MODSE患者的临床特点、影像和实验室资料、APACHEⅡ评分变化等情况。结果 64例因肺部感染诱发MODSE患者均存在≥3种基础疾病,以脑血管疾病最多,占70.3%(45/64)。全部肺部感染病原体以耐药铜绿假单胞菌54.7%(35/64)、金黄色葡萄球菌28.1%(18/64)为多见。好转41例(64.1%),死亡23例(35.9%),其中2个器官功能衰竭者死亡3例(13.1%,2/23),3个器官功能衰竭者死亡18例(72.3%,18/23),≥4个以上器官功能衰竭者2例全部死亡。存活患者APACHEⅡ评分明显低于死亡患者。结论肺部感染是诱发MODSE主要诱因之一,基础疾病、受累器官越多,APACHEⅡ评分高,抗菌药物初始治疗不合理者,病死率越高。早期、合理使用抗菌药物治疗,对肺部感染诱发的MODSE具有重要临床价值。
文摘目的探讨血必净、酚妥拉明、多巴胺联合治疗慢性阻塞性肺疾病急性加重期(AECOPD)并发多脏器功能衰竭的临床效果。方法选取2011年7月至2014年7月河北省民政总医院收治的AECOPD并发多脏器功能衰竭患者150例,按照随机数字表法分为对照组、观察A组和观察B组,每组50例。患者均接受常规治疗,观察A组在常规治疗的基础上加用5%葡萄糖200 m L+酚妥拉明10 mg+多巴胺20 mg,静脉滴注;观察B组在常规治疗基础上,加用血必净100 m L每日2次静脉滴注,联合5%葡萄糖200 m L+酚妥拉明(10 mg)+多巴胺(20 mg),静脉滴注。治疗周期为15 d。比较三组的临床疗效及治疗前后炎症指标[外周血白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)],凝血功能指标[血浆D-二聚体、血小板计数(PLT)、纤维蛋白原(Fib)]及心功能指标[左心室射血分数(LVEF)]。结果对照组、观察A组和观察B组总有效率分别为42.0%(21/50)、62.0%(31/50)和80.0%(40/50),三组临床疗效比较差异有统计学意义(P<0.05),且观察B组总有效率高于对照组和观察A组(P<0.05)。治疗后观察B组患者WBC、CRP及PCT水平分别为(10.0±3.1)×109/L、(20±6)mg/L、(0.23±0.11)μg/L,且显著低于对照组[(17.2±5.8)×109/L、(61±8)mg/L、(0.71±0.19)μg/L]和观察A组[(17.6±2.2)×109/L、(61±9)mg/L、(0.69±0.27)μg/L],差异均有统计学意义(P<0.05)。治疗后三组患者PLT和LVEF水平显著上升,Fib及D-二聚体水平均显著下降;观察A组PLT和LVEF水平为(160±45)×109/L、(57±5%),观察B组分别为(201±50)×109/L、(61±5)%,均显著高于对照组[(138±36)×109/L、(54±4)%],且观察B组显著高于观察A组,差异有统计学意义(P<0.05);观察A组Fib、D-二聚体水平为(3.9±0.9)g/L、(1.2±0.8)mg/L,观察B组分别为(3.2±1.0)g/L、(0.7±0.2)mg/L,均显著低于对照组[(4.4±0.9)g/L、(1.6±0.6)mg/L],且观察B组显著低于观察A组,差异有统计学意义(P<0.05)。结论常规治疗基础上,加用血必净+酚妥拉明+多巴胺治疗AECOPD并发多脏器功能衰竭,能快速有效地改善患者炎症、凝血功能及心脏功能,疗效显著,优于单用酚妥拉明+多巴胺联合常规疗法,值得推荐。
