登革熱休克症候群合併腸阻塞之案例報告

A Case Report in a Child with Ileus Post Type II Dengue Hemorrhagic Fever

陳怡瑾(Yi-Chin Chen) ； 郭光哲(Kuang-Che Kuo) ； 陳文嘉(Wen-Chia Chen) ； 林雅玲(Yea-Ling Lin) ； 李榮明(Zon-Min Lee)

《臺灣臨床藥學雜誌》 24卷4期 (2016/12) Pp. 352-359

https://doi.org/10.6168/FJCP.2016.2404.11

摘要

由病媒蚊叮咬而傳播病毒感染的登革熱在臺灣，尤其是南部地區是很常見且盛行率高的疾病，造成死亡的案例也不在少數。其中，登革熱休克症候群 (dengue shock syndrome, DSS) 感染初期症狀和典型登革熱類似，大部分會有發高燒、肌肉痛、骨關節疼痛、皮疹等現象，主要差別在於發病4 至7 天內，病患的微血管通透性增加，導致血漿滲出、血比容上升、肋膜積水、血小板下降、合併低血壓等。DSS 病人引起酸血症、電解質異常、併發散播性血管內凝固、導致大量出血，死亡率可高達12 ~44%，一般而言，年齡會影響登革熱症狀的表現，學齡兒童通常病程較快且症狀較輕微。文獻回顧曾報導登革熱出血症候群合併腹痛、胃腸道出血，急性肝炎、胰臟炎、膽囊炎、腎衰竭、及中樞神經抑制等嚴重的狀況。本案例報導一位無任何系統疾病的11 歲男童，罕見地在感染登革熱之後發生嚴重的麻痺性腸阻塞，用以提醒臨床醫療人員審慎評估登革熱造成消化系統方面的變化，避免不必要的外科手術及侵入性處置而造成嚴重的併發症，以及說明DSS 病人使用高滲透壓、高濃度營養液的經驗。

關鍵字

登革熱休克症候群 ； 腸阻塞 ； 全靜脈營養

並列摘要

Dengue virus infection, spread by the vector mosquito bites, is very common and highly prevalent over Taiwan, especially in the southern region. Some cases may lead to death. The early symptoms of dengue shock syndrome (DSS) are similar to those of typical dengue, and most sufferers have a high fever, muscle pain, bone and/or joint pain, skin rashes, etc. The main difference is that patients with DSS, 4 ~ 7 days post outbreak, may develop increased microvascular permeability which leads to plasma exudation, as well as elevation of hematocrit, pleural effusion, thrombocytopenia, hypotension, etc. The mortality rate of patients with DSS is up to 12 ~ 44% due mainly to acidosis, electrolyte abnormalities, and concurrent disseminated intravascular coagulation-induced massive bleeding as well. In general, the age will affect the prognosis of dengue symptoms. The course of disease in school-age children are usually faster and the symptoms are milder. Previous studies had reported that serious dengue hemorrhagic situations may cause abdominal pain, gastrointestinal bleeding, acute hepatitis, pancreatitis, cholecystitis, renal failure, and central nervous system suppression. Here we reported a rare case of severe ileus after dengue infection in an 11-year-old boy without previous systematic disease history, to alert clinicians pay more attention to the changes of digestive system caused by dengue virus, and avoid unnecessary invasive surgery and procedures that may lead to more serious complications. In addition, we shared the experience of using parenteral nutrition with high osmotic pressure and concentration for the treatment of a DSS patient.

並列關鍵字

Dengue Shock Syndrome ； Ileus ； Total Parenteral Nutrition