Fournier坏疽的感染特点及负压治疗的效果评价  

Infective characteristics of Fournier gangrene and evaluation of effect of negative pressure wound therapy

作　　者：何睿[1] 齐心[1] 温冰[1] 谢昆[1] 李强[1] 周常青[1] He Rui;Qi Xin;Wen Bing;Xie Kun;Li Qiang;Zhou Changqing(Department of Plastic and Burn Surgery,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院整形烧伤外科,100034

出　　处：《中华创伤杂志》2021年第5期390-394,共5页Chinese Journal of Trauma

摘　　要：目的总结Fournier坏疽(FG)的感染特点并探讨负压伤口疗法(NPWT)治疗F G的疗效。方法采用回顾性病例对照研究分析2010年5月至2020年9月北京大学第一医院整形烧伤外科收治的31例F G患者的临床资料,其中男29例,女2例;年龄21〜78岁[(55.2±2.0)岁]。29例发病原因为肛周和泌尿系统感染,1例为外阴感染,1例为腹膜后脓肿:23例接受NPWT(A组),8例接受常规敷料换药(B组)。观察并记录患者的病原菌特点、耐药率、治疗药物及预后。比较两组住院时间、手术次数、伤口愈合时间。结果FG患者单一细菌感染14例,混合感染15例,真菌1例,培养阴性1例。常见病原菌包括大肠埃希菌、粪肠球菌、屎肠球菌、肺炎克雷伯菌、溶血葡萄球菌。革兰阴性杆菌对H代头孢菌素耐药率为37%,革兰阳性球菌中溶血葡萄球菌均为耐甲氧西林葡萄球菌经验性抗感染治疗均选用碳青霉烯类抗生素联合万古霉素类抗生素。3例患者死亡,余28例患者均随访至出院后3〜12个月[(10.8±2.6)个月],伤口均愈合良好,未见复发。A组住院时间为(37.4±15.0)d,B组为(47.0±16.0)d(P>0.05);A组手术次数为3(3,6)次,B组为13(4,17)次(P<0.05);A组伤口愈合时间为(38.9+17.8)d,B组为(61.8+14.2)d(P<0.05)。结论肠道杆菌、肠道球菌以及溶血葡萄球菌是FG常见的病原菌,其中耐药菌比例较高。与常规敷料换药相比,NPWT能有效减少手术次数,缩短伤口愈合时间。Objective To summarize the infective characteristics of Fournier's gangrene(FG)and evaluate the effect of negative pressure wound therapy(NPWT).Methods A retrospective case control study was conducted to analyze the clinical data of 31 patients with FG admitted to Peking University First Hospital from May 2010 to September 2020,including 29 males and 2 females,aged 21-78 years[(55.2±2.0)years].A total of 29 patients were caused by infectious diseases of the perianal and urinaiy system,and the rest two patients were caused by vulvar infection and retroperitoneal abscess.A total of 23 patients were treated with NPWT(Group A)and 8 patients were treated with conventional dressing(Group B).Characteristics of pathogen,drug-resistance rate,medic al treatment and prognosis for all patients were summarized.The hospitalization duration,numbers of operation and wound healing time were compared between two groups.Results Monomicrobial infection was identified in 14 patients,while polymicrobial infection in 15 patients,fungal infection in 1 and culture-negative in 1.Escherichia coli,Enterococcus faecal is,Enterococcus faecium,Klebsiella pneumoniae and Staphylococcus haemolyticus were the most common pathogenic bacteria.The resistance rate of gram-negative bacilli to third-generation cephalosporins was 37%.Staphylococcus haemolyticus were methicillin-resistant Staphylococcus.The carbapenem antibiotics combined with vancomycin antibiotics were used for all patients as the empirical anti-infection treatment.Three patients died,and the rest 28 patients were followed up for 3 to 12 months[(10.8±2.6)months]after discharge.All the wounds were healed well without recurrence.In Group A and Group B,the hospitalization duration was(37.4±15.0)days and(47.0±16.0)clays,respectively(P>0.05);the number of operation was 3(3,6)times and 13(4,17)times,respectively(P<0.05);the wound heding time was(38.9±17.8)days and(61.8±14.2)days,respectively(P<0.05).Conclusions Enterohacteriaceae,Enterococcus and Staphylococcus haemolyticus are the most

关 键 词：FOURNIER坏疽 负压伤口疗法 坏死性筋膜炎 抗菌药 预后 

分 类 号：R446.5[医药卫生—诊断学] R632[医药卫生—临床医学]