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目的探讨小儿铜绿假单胞菌脓毒症的临床特点及其治疗措施。方法对广州市妇女儿童医疗中心儿童医院院区2008年5月-2010年7月收治的7例铜绿假单胞菌脓毒症病例资料进行回顾性分析。结果 7例铜绿假单胞菌脓毒症患儿中男6例,女1例;5例年龄<1岁,最大2岁。2例患儿有基础疾病,分别为阑尾炎行阑尾切除术和粒细胞减少症;4例为社区获得性感染,3例为院内感染。患儿均有发热、皮肤损害和多器官功能损害,皮肤损害表现为坏疽性深脓疱疹,全身均可分布,肛门周围皮肤多有受累(4/7例),5例存在深部组织和体内器官的化脓性病变。患儿血培养铜绿假单胞菌均阳性,血清超敏CRP均升高,其中3例患儿还有1个或1个以上病灶组织培养出铜绿假单胞菌;外周血白细胞计数和血小板计数多降低(5/7例),患儿出现高胆红素血症和低清蛋白血症。7例入院后均进行抗生素治疗,5例住院早期即使用敏感抗生素;6例住院期间进行外科手术,2例行多次血浆置换、连续静脉-静脉血液滤过单独或联合治疗。治愈或好转出院6例,死亡1例,平均住院天数33 d。结论社区获得性铜绿假单胞菌脓毒症并不罕见,坏疽性深脓疱疹是铜绿假单胞菌脓毒症的特征性表现。早期使用有效抗生素、适时的外科干预治疗很重要,对多器官功能损害的患者血液净化治疗有助于改善病情。
Objective To investigate the clinical features and treatment of Pseudomonas aeruginosa sepsis in children. Methods The data of 7 cases of Pseudomonas aeruginosa sepsis admitted to Children’s Hospital of Guangzhou Children’s Medical Center from May 2008 to July 2010 were retrospectively analyzed. Results There were 6 males and 1 females in 7 cases of Pseudomonas aeruginosa sepsis; 5 cases were under 1 years old and the maximum was 2 years old. Two children had underlying diseases, appendectomy and granulocytopenia, respectively; four were community-acquired and three were nosocomial infections. Children have fever, skin damage and multiple organ damage, skin damage manifested as gangrenous deep pustular herpes, can be distributed throughout the body, the skin around the anus have more involvement (4/7 cases), 5 cases of deep tissue and internal organs Purulent lesions. Children with Pseudomonas aeruginosa blood culture were positive, elevated serum CRP were elevated, of which 3 children with 1 or more lesions of Pseudomonas aeruginosa tissue culture; peripheral blood leukocyte count and platelet count More reduction (5/7 cases), children with hyperbilirubinemia and hypoalbuminemia. Seven patients were treated with antibiotics after admission. Five patients were treated with sensitive antibiotics in the early stage of hospitalization. Six patients underwent surgery during hospitalization. Two patients underwent multiple plasma exchange and continuous venovenous hemofiltration alone or in combination. 6 cases were cured or improved and 1 case died, the average length of stay was 33 days. Conclusions Community-acquired Pseudomonas aeruginosa sepsis is not uncommon and gangrenous deep pustular herpes is a characteristic manifestation of Pseudomonas aeruginosa sepsis. Early use of effective antibiotics, timely surgical intervention is very important for patients with multiple organ dysfunction blood purification treatment can help to improve the condition.