坏死性筋膜炎病例特征及感染病原菌分析  

Retrospective analysis of the clinical cases of necrotizing fascitis

作　　者：许月芳 张辉[1] 曾妙甜[1] 朱自满 Xu Yuefang;Zhang Hui;Zeng Miaotian;Zhu Zhiman(Department of Pharmacy of Medical Supplies Center,PLA General Hospital,Bejing 100048,China;Department of Hepato-Pancreato-Biliary Surgery,the First Medical Center of PLA General Hospital,Bejing 100853,China)

机构地区：[1]解放军总医院医疗保障中心药剂科,北京100048 [2]解放军总医院第一医学中心肝胆胰外科医学部,北京100853

出　　处：《中华普外科手术学杂志（电子版）》2022年第5期564-567,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的分析坏死性筋膜炎的诊治情况,为临床治疗坏死性筋膜炎提供参考。方法回顾性分析2017年1月至2021年9月收治的36例坏死性筋膜炎患者资料。数据用SPSS23.0软件进行分析,连续变量以中位数和中位数绝对偏差(MAD)表示,分类变量以[例(%)]表示,采用Fisher精确检验进行比较。结果36例患者中男性25例(69.4%),女性11例(30.6%),男性明显多于女性。平均年龄51.5岁(中位数56.5岁,中位数绝对偏差为13.0)。常见诱因是外伤、手术、蚊虫叮咬等。最主要的危险因素是糖尿病(50%),其次高风险因素是高血压、心脏疾病。坏死性筋膜炎全身都可能发病,但常见于四肢、会阴、臀部、颈部、肛周。实验室风险指标评分、CT、MRI有助于该疾病的诊断,手术探查是最佳的确诊手段。27例患者获得微生物结果,其中I型混合感染15例(55.6%),Ⅱ型单细菌感染10例(37%),IV型真菌感染型2例(7.4%)。最常见的致病菌为葡萄球菌属、肠球菌属、链球菌属、假单胞菌属、不动杆菌属、克雷伯氏菌属、大肠埃希菌属。结论治疗坏死性筋膜炎需要早期诊断,尽早清创引流,选择合适的抗感染药物,进行恰当的辅助治疗。Objective To investigate the diagnosis and treatment of necrotizing fascitis in and to provide reference for clinical treatment of necrotizing fascitis.Methods Data of 36 patients with necrotizing fascitis admitted from January 2017 to September 2021 were collected and analyzed retrospectively.Data were analyzed by SPSS 23.0 sofware,continuous variables were expressed as median and median absolute deviation(MAD),categorical variables were expressed as[example(%)],and Fisher exact test was used for comparison.ResultsAmong the 36 patients,there were 25 males(69.4%)and 11 females(30.6%)and the number of males was significantly higher than that of females.The mean age were 51.5 years(median=56.5,median absolute deviation=13.0).Common causes are trauma,surgery,and mosquito bies.The main risk factor was diabetes mellitus(50%),followed by hypertension,heart disease.Necrotizing fascitis can occur throughout the body,but it is more common in the extremities,perineum,buttocks,neck,and perianal.Laboratory risk indicators SIARI score,LRINEC score,CT and MRI are helpful for the diagnosis of this disease,and surgical exploration is the best diagnostic means.Microbiological results were obtained in 27 patients,including 15 with type I mixed infection(55.6%),10 with type Ⅱ single bacterial infection(37%),and 2 with type Ⅳ fungal infection(7.4%).The most common pathogenic bacteria were Staphylococcus,enterococcus,streptococcus,pseudomonas,acinetobacter,Klebsiella and Escherichia coli.Conclusion The treatment of necrotizing fascitis requires early diagnosis,detrauma and drainage,selection of appropriate anti-infective drugs and appropriate adjuvant therapy.

关 键 词：筋膜炎 坏死性 软组织感染 病例特征 微生物 清创引流 

分 类 号：R656[医药卫生—外科学]