产褥期泌尿系感染致脓毒性休克一例

A Case of Septic Shock Caused by Puerperal Urinary Tract Infection

摘要: 产褥期脓毒性休克是孕产妇死亡的主要原因之一，早期识别和及时干预是改善预后的关键。本文报告1例38岁产妇，在顺产后22天因泌尿系感染迅速发展为脓毒性休克合并多器官功能障碍。患者有双肾多发结石病史，本次感染源于结石梗阻导致的肾盂肾炎。通过多学科协作，采取紧急肾造瘘引流、精准抗感染治疗(根据宏基因组二代测序结果调整抗生素方案)、重症监护支持以及二期碎石取石手术，患者最终康复出院。本病例强调了在处理产褥期脓毒性休克时，遵循早期目标导向治疗原则、尽快控制感染源以及应用新型分子诊断技术指导精准治疗的重要性，以期为类似病例的临床救治提供参考。

Abstract: Puerperal septic shock is a leading cause of maternal mortality, and early recognition along with timely intervention is critical to improving clinical outcomes. This report presents a case of a 38-year-old postpartum woman who developed rapid progression from a urinary tract infection to septic shock complicated by multiple organ dysfunction 22 days after an uncomplicated vaginal delivery. The patient had a history of bilateral nephrolithiasis, and the current infection originated from pyelonephritis secondary to obstructive calculi. Through multidisciplinary collaboration—including emergency nephrostomy drainage, precision antimicrobial therapy adjusted according to metagenomic next-generation sequencing results, intensive care support, and staged lithotripsy with stone removal, the patient ultimately recovered and was discharged. This case highlights the importance of adhering to early goal-directed therapy principles, prompt source control, and the application of advanced molecular diagnostic techniques to guide precision treatment in the management of puerperal septic shock, aiming to provide a reference for the management of similar clinical cases.