外伤后细菌性致死性肉芽肿4例再探讨  

Further exploration of bacterial fatal granuloma after trauma: treatment of four patients

作　　者：高天文[1] 李春英[1] 刘仲荣[1] 徐修礼[2] 孙东杰[1] 齐显龙[1] 刘斌[1] 王刚[1] 赵小东[1] 李廷慧[1] 樊平申[1] 王胜春[1] 王津存[3] 师建国[4] 宴培松[4] 赵刚[3] 孙怡群[2] 郝晓柯[2] 丁振若[2] 刘玉峰[1] 

机构地区：[1]第四军医大学西京医院全军皮肤病中心,陕西西安710032 [2]第四军医大学西京医院检验科,陕西西安710032 [3]第四军医大学西京医院神经内科,陕西西安710032 [4]第四军医大学病理教研室,陕西西安710032

出　　处：《临床皮肤科杂志》2005年第8期513-516,共4页Journal of Clinical Dermatology

基　　金：国家自然科学基金资助项目(30271196)

摘　　要：目的:再探讨外伤后细菌性致死性肉芽肿。方法:回顾性分析4例外伤后细菌性致死性肉芽肿的临床诊治过程,根据抗生素治疗中患者皮损、颅脑磁共振成像变化及最终结果,总结该病的治疗近况,提出抢救治疗的措施。结果:从3例患者皮损中成功分离出相同的严格厌氧性多形态杆菌,根据药敏试验结果选用敏感抗生素治疗,对皮损有明显效果,但颅脑损害无改善,最终,1例无颅脑损害的患者治愈,3例伴颅脑损害的患者死亡。结论:外伤后细菌性致死性肉芽肿的治疗相当棘手,对于尚未累及颅脑的感染,林可霉素联合多西环素可作为首选。若已有颅内感染,除应用抗生素外,需积极考虑外科手术以期挽救患者生命。Objective: To explore the treatment of bacterial fatal granuloma after trauma. Methods: By analyzing of the clinicaldata and process of treatment of 4 typical cases of bacterial fatal granuloma after trauma, and depending on the changes of skinlesions, MR images of the brain and the final outcome of the patients, the therapeutic regimen and measures of the disease wereproposed. Results: The same strictly anaerobic polymorphic bacteria were successfully isolated in the skin lesions from three ofthe four patients, sensitive antibiotics according to the results of drug sensitivity test were used, and significant efficacies of theskin lesions were observed, but had no response on brain lesions. The final outcome showed one patient with no brain lesioncured and the other three with brain lesions died. Conclusions: It is still a grim challenge for the treatment of bacterial fatalgranuloma after trauma. Lincomycin combined with doxycycline might be the first choice for the patients with no brain lesions, andsurgery should be considered besides effective antibiotics when the brain has been involved.

关 键 词：肉芽肿 致死性 细菌性 外伤后 治疗 

分 类 号：R754.9[医药卫生—皮肤病学与性病学]