急性坏死性筋膜炎合并多器官功能障碍1例  

Acute necrotizing fasciitis complicated with multiple organ dysfunction:one case report

作　　者：李强[1] 李超 汪宗昱[1] 伊敏[1] 朱曦[1] Li Qiang;Li Chao;Wang Zongyu;Yi Min;Zhu Xi(Department of Critical Care Medicine,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院危重医学科,100191

出　　处：《中华危重病急救医学》2019年第11期1423-1424,共2页Chinese Critical Care Medicine

基　　金：国家科技重大专项基金(2018ZX10101004);北京市自然科学基金(7162199);首都医学发展科研基金(2009-1014)。

摘　　要：急性坏死性筋膜炎的治疗主要包括早期充分切开引流、使用有效抗菌药物和积极器官功能支持治疗。2018年1月4日,北京大学第三医院重症医学科(ICU)收治1例50岁男性A组链球菌感染导致右下肢急性坏死性筋膜炎合并多器官功能障碍患者,患者病情进展迅速,入院数小时内病变即由右侧小腿快速进展至整个右下肢,且合并中毒性休克综合征和多器官功能障碍。在给患者行右下肢深筋膜切开减压引流术和右下肢高位离断手术,给予抗菌药物联合抗感染、丙种球蛋白辅助抗感染、抗休克、床旁连续血液滤过等综合治疗后,病情好转,转出ICU。本例患者成功救治的关键在于:当肢体出现急性坏死性筋膜炎、病情进展迅猛时,果断截肢去除感染病灶,早期经验性联合应用广谱抗菌药物并给予积极器官功能支持治疗。The treatment of acute necrotizing fasciitis consists of early and aggressive incision and drainage,together with effective antibiotics and active organ support.On January 4th,2018,a 50-year-old man admitted to intensive care unit(ICU)of Peking University Third Hospital was diagnosed with acute necrotizing fasciitis in the right lower extremity caused by group A Streptococcal infection complicated with multiple organ dysfunction.The disease progressed rapidly.The lesion rapidly spread from the right calf to the entire right lower limb and was associated with septic shock and multiple organ dysfunction within a few hours after admission.The treatment included surgical debridement and amputation of his right lower extremity,multiple antimicrobials combination therapy,gamma globulin-assisted anti-infection,anti-shock,bedside continuous hemofiltration and other comprehensive treatment.The patient was successfully cured.The key to successful treatment of this patient is that when the acute necrotizing fasciitis progresses rapidly,amputation should be done to debride the infected lesions,together with early empirical broad-spectrum antibiotics combination therapy and active organ function support treatment.

关 键 词：急性坏死性筋膜炎 严重感染 去除感染病灶 抗菌药物 

分 类 号：R6[医药卫生—外科学] R45[医药卫生—临床医学]