坏死性软组织感染的临床特征及应用综合序贯诊疗策略的临床效果  

Clinical characteristics of necrotizing soft tissue infection and the clinical effect of comprehensive sequential diagnosis and treatment strategy

作　　者：陈泽群 褚万立[1] 申传安[1] 祝红娟 叶祥柏 王星童 赵帆 张路 宋垚垚[1] Chen Zequn;Chu Wanli;Shen Chuanan;Zhu Hongjuan;Ye Xiangbai;Wang Xingtong;Zhao Fan;Zhang Lu;Song yaoyao(Department of Burns and Plastic Surgery,Fourth Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第四医学中心烧伤整形医学部,北京100048

出　　处：《中华损伤与修复杂志（电子版）》2022年第4期300-307,共8页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：国家自然科学基金(82102320);解放军总医院军事医学青年专项(QNC19039);解放军总医院科技创新苗圃基金项目(18KMM45)。

摘　　要：目的探讨坏死性软组织感染(NSTI)病例的临床特征,及对其采取综合序贯诊疗策略后的临床治疗效果。方法回顾性分析解放军总医院第四医学中心烧伤整形医学部烧伤科三病区2016年1月至2021年5月采用综合序贯诊疗策略[包括早期及时诊断、全身治疗、尽快清创、反复清创结合持续负压创面治疗联合灌洗(NPWTi)、序贯性封闭创面]治疗的NSTI患者病例资料。收集并分析患者的临床特征,包括一般资料(性别、年龄、糖尿病史、病因、创面部位等)、创面感染病原菌和NSTI分型;统计患者的治疗资料,包括患者出院时创面愈合情况(治愈、好转、未愈),截肢/趾情况,结肠造瘘情况,治愈患者的手术次数、NPWTi治疗时间、住院时间。结果本研究共纳入分析NSTI患者45例,其中男34例,女11例;年龄1.0~82.0岁,平均年龄(52.4±16.2)岁;23例(51.11%)患者既往有2型糖尿病病史;按照病因分类,其中疖、带状疱疹等导致的皮肤感染13例,压力性损伤8例,外伤7例,糖尿病足4例,蚊虫叮咬伤4例,针灸后感染2例,药物注射后感染1例,术后感染1例,肠道吻合口瘘1例,肛周脓肿1例,病因不明3例;按照创面始发部位分类,其中四肢21例,躯干部13例,会阴部6例,颈部5例。45例患者中,34例患者创面病原菌培养阳性,共培养菌株58株,其中金黄色葡萄球菌和粪肠球菌各8株,大肠杆菌和鲍曼不动杆菌各7株,铜绿假单胞菌和肺炎克雷伯杆菌各4株,白色念珠菌1株,其他细菌共19株。NSTI 1型患者23例(67.65%),2型患者10例(29.41%),4型患者1例(2.94%)。NSTI 2型患者中,6例为金黄色葡萄球菌感染,4例为A群溶血性链球菌感染,包括2例化脓性链球菌感染和2例星座链球菌感染。1例4型患者感染真菌为白色念珠菌。45例患者中,37例患者治愈,5例患者经综合序贯治疗后病情好转提前离院,3例患者院内死亡(其中1例为转入ICU后死亡),院内病死率6.67%。2例患者行小�Objective To investigate the clinical characteristics of necrotizing soft tissue infection(NSTI)and the clinical therapeutic effect of comprehensive sequential diagnosis and treatment strategy.Methods The clinical medical records of NSTI patients treated with comprehensive sequential diagnosis and treatment strategies in the Third Ward of Senior Department of Burns and Plastic Surgery,Fourth Medical Center of PLA General Hospital from January 2016 to May 2021 were retrospectively analyzed.The comprehensive sequential diagnosis and treatment strategies included prompt diagnosis,systemic therapy,early and repeated debridement combined with negative pressure wound therapy with instillation(NPWTi)and sequential wound closing.The clinical characteristics including general data(gender,age,history of diabetes,etiology,wound site,etc.),pathogenic bacteria of wound infection and type of NSTI were collected.The treatment data of patients including the wound healing situation(cured,improved or unhealed),amputation situation,colostomy or not,and the number of operations,the NPWTi treatment time and the hospitalization time of cured patients were counted.Results Totally 45 patients were included,with 34 males and 11 females,aged 1.0-82.0 years with an average age of(52.4±16.2)years;23 patients(51.11%)had a history of type 2 diabetes.According to the etiological classification,there were 13 cases of skin infection caused by furuncle and herpes zoster,8 cases of pressure injury,7 cases of trauma,4 cases of diabetic foot,4 cases of insect bite,2 cases of infection after acupuncture,1 case of infection after drug injection,1 case of postoperative infection,1 case of intestinal anastomotic fistula,1 case of perianal abscess,and 3 cases of unknown etiology.According to the initial site of the wound,there were 21 cases of limbs,13 cases of trunk,6 cases of perineum and 5 cases of neck.Thirty-four patients had positive wound pathogen culture in 45 patients,in which 58 bacterial strain were cultivated,including 8 strains of Staphyloc

关 键 词：软组织感染 筋膜炎 坏死性 负压伤口疗法 坏疽 创面修复 

分 类 号：R64[医药卫生—外科学]