多学科联合治疗多发伤合并坏死性筋膜炎7例体会  

Experience of multidisciplinary treatment of multiple injuries with necrotizing fasciitis in 7 cases

作　　者：李大伟[1,2] 赵刚[2] 唐宇峰[2] 张颖 张众惠[3] 崔萌 杨明宇[5] LI Da-wei;ZHAO Gang;TANG Yu-jeng;ZHANG Ying;ZHANG Zhong-hui;CUI Meng;FANG Ming-yu(Department of Trauma Orthopaedics,Weihai Hospital,Weihai,Shandong 264200,China;Department of Trauma Orthopedics,Qialffoshan Hospital,Shandong University-,Jinan 250014,China;Department of ICU,Qian-foshan Hospital,Shandong University-,Jinan 250014,China;Department of Anorectal,Qialffoshan Hospital,Shandong University-,Jinan 250014,China;Department of Gastroenterology-,Qialffoshan Hospital,Shandong U-niversity-,Jinan 250014,China)

机构地区：[1]威海市立医院创伤骨科,山东264200 [2]山东大学千佛山医院创伤骨科,济南250014 [3]山东大学千佛山医院ICU,济南250014 [4]山东大学千佛山医院肛肠科,济南250014 [5]山东大学千佛山医院胃肠外科,济南250014

出　　处：《创伤外科杂志》2018年第9期647-650,共4页Journal of Traumatic Surgery

摘　　要：目的探讨多学科联合治疗多发伤合并坏死性筋膜炎的治疗体会。方法对7例严重多发伤合并坏死性筋膜炎患者以创伤骨科为主体,多学科联合治疗的模式,快速评估伤情,在行损害控制性手术的同时早期使用广谱抗生素,涉及会阴部及肛周感染患者早期行结肠造瘘术,局部的彻底清创、引流,持续氧灌注下负压封闭引流(VSD),加强生命支持等积极诊疗措施。结果坏死性筋膜炎引起的重症感染被有效控制,创面经过拉拢缝合或二期植皮、皮瓣修复后,7例患者均治愈出院。结论对于严重多发伤合并坏死性筋膜炎患者,只有通过多学科综合治疗,发挥各自专业特长,遵循损害控制的原则,在积极治疗多发伤的同时,早期评估、早期使用有效的抗生素、早期造瘘、早期积极清创、充分引流,给予负压引流协助,能有效提高抢救成功率,降低并发症的发生率。Objective To explore the experience of multidisciplinary treatment of multiple injuries with necrotizing fasciitis. Methods Seven multiple trauma patients with necrotizing fasciitis were treated with multidisciplinary combined therapy. Treatment measures included rapid assessment of injury and damage control surgery for injury,early use of broad-spectrum antibiotics,early thorough debridement and drainage,early colostomy for patients with perineum and crissum infection,closed negative pressure drainage,strengthening life support,and correcting electrolyte. Results Severe infection caused by necrotizing fasciitis was effectively controlled. After the wound was sutured or repaired by second-stage skin graft and skin flap,7 patients were cured and discharged. Conclusion For patients with severe multiple trauma and necrotizing fasciitis,active measures including multidisciplinary comprehensive treatment,following the principle of damage control,actively treating multiple injuries,early assessment,early use of effective antibiotics,early active debridement,adequate drainage,and negative pressure drainage assistance can effectively improve the success rate of treatment and reduce the incidence of complications.

关 键 词：多发伤 筋膜炎 多学科 治疗 

分 类 号：R641[医药卫生—外科学]