面部注射不明药物致脓肿分枝杆菌感染的治疗方案  

Treatment of Mycobacterium abscessus infection caused by facial injection of unknown drugs

作　　者：韩锋 秦高平[1] 朱媛[2] 张松 李建武 孙要文[1] Han Feng;Qin Gaoping;Zhu Yuan;Zhang Song;Li Jianwu;Sun Yaowen(Department of Burn Plastic Surgery of Shaanxi Provincial People’s Hospital,Xi’an 710068,China;Ultrasound Diagnosis Center of Shaanxi Provincial People’s Hospital,Xi’an 710068,China)

机构地区：[1]陕西省人民医院烧伤整形医学美容外科,西安710068 [2]陕西省人民医院超声诊断中心,西安710068

出　　处：《中华整形外科杂志》2023年第10期1074-1081,共8页Chinese Journal of Plastic Surgery

摘　　要：目的:探讨面部注射不明药物导致脓肿分枝杆菌感染的局部组织损伤特征及治疗方案。方法:回顾性分析2021年9月至2022年6月陕西省人民医院收治的注射不明药物("溶骨针")导致面部脓肿分枝杆菌感染患者的临床资料。术前采集感染部位分泌物行涂片检查,并行超声、CT、MRI及其他相关检查。在内镜辅助和B超引导下对感染部位进行外科清创术,术中可见感染侵及面部浅表肌腱膜系统,甚至深层肌肉及骨组织,彻底清除坏死、变性组织,将分泌物送细菌培养及药敏试验,切除的组织送病理学检查,行HE染色。清创术后伤口不缝合,采用负压封闭引流(VSD)技术进行治疗,以50 ml生理盐水+阿米卡星10万U冲洗腔内,待创面完全新鲜、分泌物培养阴性后再缝合。药物治疗:首先根据分泌物涂片检查结果(抗酸杆菌阳性),经验性应用头孢西丁或阿米卡星注射液,经细菌培养确诊后加用口服克拉霉素及米诺环素治疗,并口服双环醇片保护肝功能;根据药敏试验结果住院期间静脉滴注头孢西丁或阿米卡星注射液;出院后继续口服克拉霉素或米诺环素及双环醇片3~6个月,每2周复查1次血常规及肝肾功能;定期门诊复查,观察伤口是否有感染复发及颌面部外观恢复情况。结果:共纳入10例患者,男1例,女9例,年龄19~28岁,平均25.3岁,临床表现为颧部、颊部、眼周或颞前局部红肿,皮温不高,皮肤破溃,有脓性分泌物,扪之有硬结。CT及MRI显示,面部软组织有不同程度肿胀、积液,局部结构层次及骨质被破坏;分泌物培养结果均为脓肿分枝杆菌感染;药敏试验结果:对米诺环素、头孢西丁、阿米卡星敏感;HE染色示组织有渗出、增生和坏死性病变,有慢性化脓性炎症和混合性肉芽肿病变。10例患者住院治疗12~28 d,面部感染得到很好控制,创面愈合良好,经6个月随访,面部均无感染复发,外观基本恢复正常。结论:面部�ObjectiveTo analyze the characteristics of local histological damage in patients with Mycobacterium abscessus infection caused by facial drug injection,and propose a treatment.MethodsThe patients of Mycobacterium abscessus infection caused by facial injection of unknown drugs("osteolytic needles")admitted to Shaanxi Provincial People’s Hospital from September 2021 to June 2022 were analyzed retrospectively.Secretions were collected from the infected site for smear examination before surgery,and perform ultrasound,CT,MRI,and other related examinations.Surgical debridement was performed on the infected site under the assistance of endoscope and the guidance of B-ultrasound.During the operation,the infection was demonstrated to affect the facial superficial musculoaponeurotic system,even the deep muscle and bone tissue.The necrotic and degenerative tissue was completely removed and then the secretion was sent to bacterial culture and drug susceptible test,and the resected tissue was sent to pathological examination for HE staining.After debridement,the wound was not sutured.The vacuum sealing drainage(VSD)technique was used to treat the wound.The cavity was irrigated with 50 ml of normal saline+100000 U of amikacin,and the wound was sutured after the wound was completely healthy and the secretion culture was negative.Drug treatment:first,according to the results of secretion smear examination(positive acid-fast bacteria),empirically apply cefoxitin or amikacin injection.After the infection was confirmed by bacterial culture,oral clarithromycin and minocycline were added,and bicyclol tablets were orally administered to protect liver function.Intravenous drip of cefoxitin or amikacin injection during hospitalization according to the results of drug susceptible test.After discharge,clarithromycin or minocycline and bicyclol tablets were used for 3-6 months,and the blood routine test and liver and kidney functions were examined every 2 weeks.Regular outpatient re-examination was carried out to observe whether there is

关 键 词：脓肿分枝杆菌 分枝杆菌感染 面部注射 组织损伤 清创术 负压封闭引流 溶骨针 

分 类 号：R622[医药卫生—整形外科]