嚴(yán)重?zé)齻笊铎o脈導(dǎo)管相關(guān)感染并發(fā)顱內(nèi)多發(fā)性膿腫一例-閱讀頁
2024-10-04 12:50本頁面
【正文】 gh fever. Considering there was possibility of staphylococcus aureus infection, the right femoral vein catheter was pulled off and usd for bacteria culture, antibiotic was adjusted into vincocin 500mgq6h intravenous infusion, and the wound secretion was used again for bacteria culture and blood days later, vein catheter, wound secretion and blood bacteria culture were all methicillin resistant staphylococcus aureus grow (MRSA), being sensitive to vanycin through vitro drug sensitivity test. Continue to intravenously drippinginject with vanycin, patient body temperature dropped to some extent, but gradually appeared symptoms of looking indifference, lazy speaking, and limbs weakness. After 6 days of intravenous infusion of vanycin, left upper extremity muscle strength weakness was found ( degree III). Craniocerebral inspection was made and indicated: there were multiple flake style T1, T2 signal density with obscure realm in right cerebella hemisphere, temporal lobe and front lobe. Pressurized water sequence image showed high signal, enhanced scan showed evident ring enhancement or inplete enhancement, and partial cerebral sulcus and cerebral fissure got narrowed. The biggest focus lied in right temporal lobe and the size was about 3cm, and there were still seperated tiny specks of focus in both sides of brain and left showed there was multiple infection focus in both sides of brain and cerebella and some abscess had formed. Combined with clinic data it was diagnosed to be cerebral multiple MRSA infection after burnt and some abscess had was transferred to neurology department, vanycin continued to be used and bined with fosfomycin sodium to prevent infection with treatment of mannitol dehydrating to reduce cerebral pressure. One week later patient died of abscess rupture.討論：燒傷后感染等并發(fā)癥至今仍然是燒傷治療中棘手的問題之一，特別是多重耐藥細(xì)菌的感染并發(fā)癥。感染多為血源播散性,與嚴(yán)重?zé)齻髾C(jī)體免疫功能低下易發(fā)生侵襲性感染有關(guān)，也有醫(yī)源性因素如深靜脈導(dǎo)管的相關(guān)性感染所致[2]。燒傷后由耐甲氧西林的金黃色葡萄球菌（MRSA）所致的顱內(nèi)感染較為少見，1992年Suzuki 報(bào)道一例[3]。本例燒傷面積為35%，燒傷創(chuàng)面主要分布在頭面部和四肢暴露部位，因常用的外周靜穿刺部位均被燒傷而選擇了深靜脈置管。盡管選用了敏感抗菌素，但萬古霉素難以透過血腦屏障，局部組織難以達(dá)到有效的殺菌濃度，最終治療失敗。但在臨床實(shí)際工作中，對(duì)大面積深度燒傷病例，留置深靜脈導(dǎo)管有時(shí)在所難免，但要盡可能選擇血流速度快，不易形成血栓的部位，如頸內(nèi)靜脈、鎖骨下靜脈等。因此,達(dá)到治療目的后,應(yīng)盡早拔除,需要較長(zhǎng)時(shí)間使用的,應(yīng)定期重新穿刺,更換導(dǎo)管。此外,留置深靜脈導(dǎo)管后,還應(yīng)加強(qiáng)插管部位皮膚的護(hù)理，保持局部干燥、清潔，導(dǎo)管內(nèi)使用抗凝劑，采用抗生素鎖技術(shù)等也能有效地減少深靜脈導(dǎo)管相關(guān)性感染的發(fā)生
環(huán)評(píng)公示相關(guān)推薦
鄂ICP備17016276號(hào)-1