LESSONS LEARNED IN THE MANAGEMENT OF HEMOLYTIC-UREMIC SYNDROME IN CHILDREN
LESSONS LEARNED IN THE MANAGEMENT OF HEMOLYTIC-UREMIC SYNDROME IN CHILDREN
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DOI：
10.1016/0022-3468(95)90554-5
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发表时间：
1995-02-01
影响因子：
2.4
通讯作者：
WALDHAUSEN, J
中科院分区：
文献类型：
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作者：
TAPPER, D;TARR, P;WALDHAUSEN, J
大肠杆菌 O157:H7 是一种严重且常见的人类病原体，可引起腹泻、出血性结肠炎和溶血性尿毒症综合征 (HUS)。 1993 年 1 月华盛顿州大规模爆发大肠杆菌 O157:H7 感染期间；超过 600 人（其中大部分是儿童）出现症状感染，西雅图儿童医院和医疗中心有 37 人因 HUS 住院，华盛顿其他医院有 6 人住院。二十一名 (57%) 需要透析。 19 名 (51%) 患者有明显的肾外病理：14 名患者 (38%) 患有胃肠道疾病，13 名患者 (35%) 患有心血管疾病，9 名患者 (24%) 患有肺部疾病，6 名患者 (16%) 患有神经系统疾病。大多数患者接受非手术治疗，但三名患者需要全腹部结肠切除术，一名患者需要左结肠切除术。没有孩子出现穿孔。三名患者死亡，全部患有多系统疾病。作者建议 (1) 所有血性腹泻患者在进行任何手术干预之前均应接受大肠杆菌 O157:H7 微生物学评估； (2) 在对照试验中确定此类干预措施的安全性和有效性之前，避免对已证实或疑似感染大肠杆菌 O157:H7 的患者使用抗生素和抗动力药物； (3) 在腹泻发作后一周内，对大肠杆菌 O157:H7 感染患者进行与 HUS 一致的微血管病变变化评估； (4) 对严重症状进行鼻胃吸引，并频繁进行腹部评估、测试（电解质/淀粉酶）和X线检查，以排除可治疗的腹部疾病； (5) 因少尿/无尿、酸中毒或肌酐升高而进行血液透析。作者建议对中毒性巨结肠、结肠穿孔、透析无反应的酸中毒或反复出现的梗阻或结肠狭窄体征进行手术探查。版权所有 (C) 1995 W.B.桑德斯公司
Escherichia coli O157:H7 is a Serious and common human pathogen that can cause diarrhea, hemorrhagic colitis, and the hemolytic uremic syndrome (HUS). During a massive outbreak of infection with E coli O157:H7 in January 1993 in Washington State; more than 600 people, mostly children, acquired symptomatic infection, and 37 were hospitalized with HUS at Children's Hospital and Medical Center in Seattle, and six at other hospitals in Washington. Twenty-one (57%) required dialysis. Nineteen (51%) had significant extrarenal pathology: gastrointestinal in 14 patients (38%), cardiovascular in 13 (35%), pulmonary in 9 (24%), and neurological in 6 (16%). Most patients were managed nonoperatively, but three required total abdominal colectomy and one a left colectomy. No child had perforation. Three patients died, all of whom had multisystem disease. The authors recommend (1) that all patients with bloody diarrhea undergo microbiological evaluation for E coli O157:H7 before any surgical intervention; (2) avoidance of antibiotics and antimotility agents in patients with proven or suspected infection with E coli O157:H7 until the safety and efficacy of such interventions have been established in controlled trials; (3) that patients with E coli O157:H7 infections be evaluated for microangiopathic changes consistent with HUS in the week after onset of diarrhea; (4) nasogastric suction for severe symptoms, and frequent abdominal evaluations, tests (electrolytes/amylase), and roentgenograms to exclude treatable abdominal disorders; and (5) institution of hemodialysis for oliguria/anuria, acidosis, or rising creatinine. The authors recommend surgical exploration for toxic megacolon, colonic perforation, acidosis unresponsive to dialysis, or recurrent signs of obstruction or colonic stricture. Copyright (C) 1995 by W.B. Saunders Company