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Objective To report a case of symmetric peripheral gangrene (SPG) in septic shock. The clinical data and related literature were reviewed to discuss its characteristics, pathogenesis and treatment measures, so as to improve clinicians' understanding and treatment of the disease. Methods A 60-year-old male patient was admitted to the Changhai Hospital Affiliated to Naval Medical University on July 31, 2022 due to "left side low back pain". Before operation, he was diagnosed with malignant tumor of the left adrenal gland involving multiple organs and blood vessels. Therefore, he underwent resection of huge retroperitoneal tumor, left colon, left kidney, left suprarenal gland, part of stomach and pancreatic body tail under general anesthesia. Due to the large surgical trauma, more bleeding and low blood pressure, he was admitted to the ICU for blood transfusion, fluid infusion and pressure boosting. The literature about SPG in the past 10 years in the database of the National Library of Medicine (PubMed) was searched, and the characteristics of the disease, the related factors of the disease and the treatment measures were emphatically discussed. Results The patient developed septic shock due to intraperitoneal infection on the 3rd day after operation, and gradually developed symmetrical ischemic necrosis of both hands and feet on the 4th day. According to the characteristics of the disease and clinical features, the patient was diagnosed with SPG. A total of 18 foreign English literatures were retrieved, involving 24 SPG patients. In combination with this case, 25 patients were included, including 10 males (40%) and 15 females (60%). The male to female ratio was 1:1.5. The average age was (48.8±15.1) years for males and (49.8±16.2) years for females. There was no history of vascular related diseases in the past. The main clinical features were symmetrical ischemic necrosis of both hands and (or) lower limbs and feet (100%), which was related to septic shock (100%), microbial infection (52%), disseminated intravascular coagulation (DIC) (52%), liver function damage (20%), and the use of vasoactive drugs (80%). The treatment effect was poor, the death mortality was 24% (6/25), and the amputation rate of the surviving patients was as high as 78.9% (15/19). Only one case of blood adsorption treatment was effective. Conclusions The occurrence of SPG in septic shock patients may be related to the pathophysiological changes such as septic shock, DIC, lack of natural anticoagulants, and the role of vasoactive drugs. Clinicians need to pay great attention to improving the diagnosis and treatment of SPG.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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