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中华普外科手术学杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 564 -567. doi: 10.3877/cma.j.issn.1674-3946.2022.05.025

所属专题: 经典病例

论著

坏死性筋膜炎病例特征及感染病原菌分析
许月芳1, 张辉1, 曾妙甜1, 朱自满2,()   
  1. 1. 100048 北京,解放军总医院医疗保障中心药剂科
    2. 100853 北京,解放军总医院第一医学中心肝胆胰外科医学部
  • 收稿日期:2022-06-01 出版日期:2022-10-26
  • 通信作者: 朱自满

Retrospective analysis of the clinical cases of necrotizing fasciitis

Yuefang Xu1, Hui Zhang1, Miaotian Zeng1, Zhiman Zhu2,()   

  1. 1. Department of Pharmacy of Medical Supplies Center, PLA General Hospital, Beijing 100048, China
    2. Department of Hepato-Pancreato-Biliary Surgery, the First Medical Center of PLA General Hospital, Beijing 100853, China
  • Received:2022-06-01 Published:2022-10-26
  • Corresponding author: Zhiman Zhu
引用本文:

许月芳, 张辉, 曾妙甜, 朱自满. 坏死性筋膜炎病例特征及感染病原菌分析[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(05): 564-567.

Yuefang Xu, Hui Zhang, Miaotian Zeng, Zhiman Zhu. Retrospective analysis of the clinical cases of necrotizing fasciitis[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(05): 564-567.

目的

分析坏死性筋膜炎的诊治情况,为临床治疗坏死性筋膜炎提供参考。

方法

回顾性分析2017年1月至2021年9月收治的36例坏死性筋膜炎患者资料。数据用SPSS 23.0软件进行分析,连续变量以中位数和中位数绝对偏差(MAD)表示,分类变量以[例(%)]表示,采用Fisher精确检验进行比较。

结果

36例患者中男性25例(69.4%),女性11例(30.6%),男性明显多于女性。平均年龄51.5岁(中位数56.5岁,中位数绝对偏差为13.0)。常见诱因是外伤、手术、蚊虫叮咬等。最主要的危险因素是糖尿病(50%),其次高风险因素是高血压、心脏疾病。坏死性筋膜炎全身都可能发病,但常见于四肢、会阴、臀部、颈部、肛周。实验室风险指标评分、CT、MRI有助于该疾病的诊断,手术探查是最佳的确诊手段。27例患者获得微生物结果,其中Ⅰ型混合感染15例(55.6%),Ⅱ型单细菌感染10例(37%),Ⅳ型真菌感染型2例(7.4%)。最常见的致病菌为葡萄球菌属、肠球菌属、链球菌属、假单胞菌属、不动杆菌属、克雷伯氏菌属、大肠埃希菌属。

结论

治疗坏死性筋膜炎需要早期诊断,尽早清创引流,选择合适的抗感染药物,进行恰当的辅助治疗。

Objective

To investigate the diagnosis and treatment of necrotizing fasciitis in and to provide reference for clinical treatment of necrotizing fasciitis.

Methods

Data of 36 patients with necrotizing fasciitis admitted from January 2017 to September 2021 were collected and analyzed retrospectively. Data were analyzed by SPSS 23.0 software,continuous variables were expressed as median and median absolute deviation(MAD),categorical variables were expressed as[example(%)],and Fisher exact test was used for comparison.

Results

Among the 36 patients,there were 25 males(69.4%)and 11 females(30.6%)and the number of males was significantly higher than that of females. The mean age were 51.5 years(median = 56.5,median absolute deviation = 13.0). Common causes are trauma,surgery,and mosquito bites. The main risk factor was diabetes mellitus(50%),followed by hypertension,heart disease. Necrotizing fasciitis can occur throughout the body,but it is more common in the extremities,perineum,buttocks,neck,and perianal. Laboratory risk indicators SIARI score,LRINEC score,CT and MRI are helpful for the diagnosis of this disease,and surgical exploration is the best diagnostic means. Microbiological results were obtained in 27 patients,including 15 with typeⅠmixed infection(55.6%),10 with typeⅡsingle bacterial infection(37%),and 2 with typeⅣfungal infection(7.4%). The most common pathogenic bacteria were Staphylococcus,enterococcus,streptococcus,pseudomonas,acinetobacter,Klebsiella and Escherichia coli.

Conclusion

The treatment of necrotizing fasciitis requires early diagnosis,detrauma and drainage,selection of appropriate anti-infective drugs and appropriate adjuvant therapy.

表1 36例坏死性筋膜炎患者一般特征(例)
表2 27例患者分离微生物统计(株)
表3 铜绿假单胞菌和鲍曼不动杆菌对抗菌药物耐药率比较(%)
表4 肺炎克雷伯杆菌和大肠埃希氏菌对抗菌药物耐药率比较(%)
[4]
Cribb BIWang MTMKulasegaran S,et al. The SIARI Score:A Novel Decision Support Tool Outperforms LRINEC Score in Necrotizing Fasciitis[J]. World J Surg201943(10):2393-2400.
[5]
童院生,姜宝,郑涛,等. 2015年-2020年老年直肠癌患者术后吻合口漏的高危因素分析[J/CD]. 中华普外科手术学杂志(电子版)202216(1):56-58.
[6]
余伟儇,张传钊,王力斌,等. 结直肠癌合并糖尿病患者术后感染对机体Th17 相关因子、sICAM-1、MMP-12 表达的影响[J/CD]. 中华普外科手术学杂志(电子版)201913(5):468-471.
[7]
Kückelhaus MHirsch TLehnhardt M,et al. [Necrotizing fasciitis of the upper and lower extremities][J]. Chirurg201788(4):353-366.
[8]
Stevens DLBryant AEGoldstein EJ. Necrotizing Soft Tissue Infections[J]. Infect Dis Clin North Am202135(1):135-155.
[9]
马成民,汪刘华,王伟,等. 胃肠道手术后肠道菌群易位致全身感染2例报道[J/CD]. 中华普外科手术学杂志(电子版)201913(5):540.
[10]
Lin CNHsiao CTChang CP,et al. The Relationship Between Fluid Accumulation in Ultrasonography and the Diagnosis and Prognosis of Patients with Necrotizing Fasciitis[J]. Ultrasound Med Biol201945(7):1545-1550.
[11]
杨娟,杨先芹,张岚,等.两种清创术治疗急性胰腺炎所致感染性胰腺坏死的临床效果研究[J/CD]. 中华普外科手术学杂志(电子版)202115(6):668-671.
[12]
Kim YHHa JHKim JT,et al. Managing necrotising fasciitis to reduce mortality and increase limb salvage[J]. J Wound Care201827(Sup9a):S20-S27.
[13]
Rahim GRGupta NMaheshwari P,et al. Monomicrobial Klebsiella pneumoniae necrotizing fasciitis:an emerging life-threatening entity[J]. Clin Microbiol Infect201925(3):316-323.
[14]
梁云,郭仁妃,曾晶,等.乳腺外科术后切口感染对凝血纤溶功能及淋巴水肿的影响[J/CD]. 中华普外科手术学杂志(电子版)201812(5):400-403.
[15]
Doi Y. Treatment Options for Carbapenem-resistant Gram-negative Bacterial Infections[J]. Clin Infect Dis201969(Suppl 7):S565-S575.
[1]
Leiblein MMarzi ISander AL,et al. Necrotizing fasciitis:treatment concepts and clinical results[J]. Eur J Trauma Emerg Surg201844(2):279-290.
[2]
Chen LLFasolka BTreacy C. Necrotizing fasciitis:A comprehensive review[J]. Nursing202050(9):34-40.
[3]
Bechar JSepehripour SHardwicke J,et al. Laboratory risk indicator for necrotising fasciitis(LRINEC)score for the assessment of early necrotising fasciitis:a systematic review of the literature[J]. Ann R Coll Surg Engl201799(5):341-346.
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