6例急性坏死性筋膜炎的治疗体会  

Experience in the treatment of 6 cases of acute necrotizing fasciitis

作　　者：李庆林 LI Qinglin(Department of Burn and Plastic Surgery,Taizhou Hospital of Traditional Chinese Medicine,Taizhou 225300,China)

机构地区：[1]泰州市中医院烧伤整形科,江苏省泰州市225300

出　　处：《组织工程与重建外科》2025年第2期142-147,共6页Journal of Tissue Engineering and Reconstructive Surgery

摘　　要：目的总结急性坏死性筋膜炎的治疗经验,为临床实践提供参考依据。方法回顾性分析2021年6月至2024年10月收治的6例急性坏死性筋膜炎患者的临床资料,分析患者入院后创面性状的变化、实验室检查异常指标变化、手术方式及次数、合并症的治疗、住院时间和出院后创面随访情况。结果6例患者入院后均存在发热、血象升高,C反应蛋白及降钙素原炎性指标超标。1例右大腿皮肤大面积红肿疼痛,皮温高,压痛,波动感明显;其余5例皮肤已经出现破溃坏死伴有渗液流出,创周皮肤红肿热痛。5例有2型糖尿病史,2例有坐骨结节Ⅳ期压疮(其中1例为双侧),1例右足第二、第三足趾灰黑色糜烂坏死。入院后所有患者均接受经验性静脉滴注抗菌药物抗感染治疗,并积极调控血糖,2~6 d后患者均接受创面清创及负压封闭引流治疗,后续根据创面细菌培养结果调整抗菌药物行抗感染治疗。所有患者均存在贫血、电解质紊乱、低蛋白血症、凝血功能异常等,均给予相应对症治疗。其中2例并发胸腔积液,1例接受胸腔闭式引流治疗。所有患者创面均行清创负压封闭引流治疗,采取“浅筋膜保守清创,深筋膜彻底清创”方式。其中1例经过6次清创负压封闭引流治疗,3例经过1次,1例经过2次,1例经过3次治疗后,创面达到肉芽组织鲜红、无炎性反应的修复标准。5例患者创口通过直接拉拢缝合封闭,1例患者接受植皮封闭并行足趾截趾术,合并有坐骨结节压疮的患者同时接受臀大肌肌皮瓣修复。经过清创负压封闭引流治疗后,所有患者炎性指标显著下降,体温逐渐恢复正常,异常化验指标也逐渐趋于正常。本组患者住院时间24~91 d,出院后随访3~40个月,未见坏死性筋膜炎复发。结论急性坏死性筋膜炎的治疗需综合考虑多方面因素。积极的抗感染治疗、血糖控制以及纠正异常化验指标,以维护机体的内环Objective To summarize the treatment experience of acute necrotizing fasciitis and provide reference for clinical practice.Methods A retrospective analysis was conducted on the clinical data of six patients with acute necrotizing fasciitis from June 2021 to October 2024.The changes in wound characteristics,abnormal laboratory indicators,surgical methods and frequency,treatment of complications,length of hospital stay,and follow-up of wounds after discharge were analyzed.Results After admission,all the 6 patients had fever,elevated hemogram,and excessive inflammatory indexes of C-reactive protein and procalcitonin.One patient had extensive redness,swelling,and pain in the right thigh skin,with high skin temperature,tenderness,and obvious fluctuant sensation.In addition,five patients had skin ulceration and necrosis accompanied by exudate,and the surrounding skin was red,swollen,hot,and painful.Five patients had a history of type 2 diabetes,two patients had stage IV pressure sores in the ischial tuberosity(one was bilateral),and one patient had grayblack erosion and necrosis of the second and third toes of the right foot.After admission,all patients received empirical anti infective treatment by intravenous drip of antibiotics,and actively regulated blood glucose.After 2-6 days,all patients received wound debridement and vacuum sealing drainage,and then adjusted the anti infective treatment of antibiotics according to the results of wound bacterial culture.All patients had anemia,electrolyte disorder,hypoproteinemia and abnormal coagulation function,and were given corresponding symptomatic treatment.Two cases were complicated with pleural effusion,and one case received closed thoracic drainage.All patients were treated with debridement and vacuum sealing drainage,and the method of“conservative debridement of superficial fascia and thorough debridement of deep fascia”was adopted.Among them,1 case underwent 6 times of debridement and vacuum sealing drainage,3 cases underwent 1 time,1 case underwent 2 times,and 1

关 键 词：坏死性筋膜炎 负压封闭引流 感染 植皮 压疮 

分 类 号：R686.3[医药卫生—骨科学]