坏死性筋膜炎诊治分析及研究进展  

Clinical analysis of 10 cases of necrotizing fasciitis and the research progress

作　　者：钟洁 刘小孙[1] ZHONG Jie, LIU Xiao sun.(Department of Gastroenterology, the First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310000, China)

机构地区：[1]浙江大学医学院附属第一医院胃肠外科,杭州310000

出　　处：《中国急救复苏与灾害医学杂志》2018年第10期955-958,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：浙江省省级科技计划公益项目（2015C33174）

摘　　要：目的探讨坏死性筋膜炎（necrotizing fasciitis，NF）的临床诊断和治疗进展。方法收集2015年1月一2018年1月浙江大学医学院附属第一医院收治的诊断为坏死性筋膜炎的病例，结合文献复习，研究其人口学、流行学、诊断、治疗、预后等方面的信息。结果共发现10例坏死性筋膜炎的患者，均为男性，发病年龄36～79岁，8例为社区获得性感染，6例为身体的中心部分受累，4例为肢体受累，8例伴随合并症，坏死性筋膜炎实验室风险指数（1aboratory risk indicator for necrotizing fasciitis，LRINEC）〉6分的2例。7例检出细菌的患者中，混合感染占3例。采用外科手术治疗9例，死亡2例。结论坏死性筋膜炎的早期诊断和充分治疗是提高临床疗效的必要手段，而诊断的黄金标准是手术探查，手术清创是坏死性筋膜炎的首选治疗。Objective To investigate the clinical diagnosis and treatment of necrotizing fasciitis （NF）. Method The demographic and elinical data of 10 patients with NF diagnosed and treated in the First Affiliated Hospital of Zhejiang University School of Medicine between January 2015 and January 2018 were analyzed. Results All the 10 patients were male, aged 36~79. Eight cases were caused by community-acquired infection. In 6 cases the central part of the body was affected and in 4 patients the affected parts were extremities. 8 cases were with respective complications. The laboratory risk indicator for necrotizing fasciitis （LRINEC） scores were 〉 6 points in 2 cases. Ten strains of bacteria were detected from 7 cases, and mixed infection was seen in 3 cases. Surgical treatment was performed in 9 cases. 2 patients died. The average length of hospitalization was 22.8 days, and 3 patients had been treated in ICU. Conclusion NF is a life threatening disease with a high mortality. Early diagnosis and adequate treatment are necessary to improve the clinical outcome. Clinical awareness off necrotizing fasciitis remains pivotal, and the gold standard of diagnosis is surgical exploration. Surgical debridement is the first choice for necrotizing fasciitis. The early combined use of a large number of broad-spectrum antibioties can slow down the spread of inflammation. Nutritional support, negative pressure continuous irrigation and drainage （VSD） and hyperbaric oxygen therapy can promote the healing of wound.

关 键 词：坏死性筋膜炎 LRINEC评分 诊断 治疗 预后 

分 类 号：R686.3[医药卫生—骨科学]