- 期刊
壞死性筋膜炎與蜂窩性組織炎之評估、診斷及治療：以一位右下肢動靜脈畸形病史女性為例
Evaluation, diagnosis and treatment of necrotizing meningitis and cellulitis: a case of a woman with a history of arteriovenous malformations of the right lower extremity
摘要
個案一開始以右下肢紅腫熱痛表現入院，其肢體外觀紅腫擴大快速並形成出血性水泡，合併敗血性休克，搭配影像呈現組織膿瘍，依照壞死筋膜炎風險指標（Laboratory risk indicator for necrotizing fasciitis，LRINEC）確診為第三型壞死性筋膜炎且為中度風險，照會整形外科行筋膜切開術，但因右下肢動靜脈血管畸形病史開刀風險大且後續併發症多（出血量大、不易止血、傷口難癒合、易反覆感染、抑或截肢風險），家屬決定暫緩開刀！筆者團隊與整形外科討論後，先投予經驗性抗生素，並積極尋找可能致病源，修正抗生素使用，經後續的清瘡及植皮手術後，傷口癒合且順利出院。壞死性筋膜炎早期症狀與蜂窩性組織炎不易區分，但因毒素擴散極速且會造成皮下組織壞死，故臨床表現變化急遽。如何區辯壞死筋膜炎與蜂窩性組織炎症狀之不同之處，除需觀察臨床症狀及病史詢問外，更需影像佐證，盡快確診給予適當的處置，減少其合併症（如多重器官衰竭或截肢）及降低死亡率！
並列摘要
The patient was admitted to the hospital with redness, swelling, heat and pain in his right lower extremity. The appearance of his limbs became redness and swollen rapidly and formed black blisters that combined with septic shock, and tissue abscesses were presented with images. According to the Laboratory risk indicator for necrotizing fasciitis (LRINEC), he was diagnosed with Type III necrotizing fasciitis and moderate risk. The author consulted with plastic surgery for fasciotomy, but due to his history of arteriovenous and vascular malformations of the right lower limb, the risk of surgery was high and subsequent complications were a lot (such as massive bleeding and difficult to stop bleeding; wounds were difficult to heal; wounds were prone to repeated infections; and risk of amputation).The family decided to postpone the operation! After discussing with plastic surgery, the author's team used administered empirical antibiotics first, actively searched for possible pathogens, corrected the use of antibiotics, and after subsequent debridement and skin grafting. The wound healed the patient and was discharged smoothly. The early symptoms of necrotizing fasciitis and cellulitis are difficult to distinguish, but the rapidly spread of toxins and necrosis of the subcutaneous tissue result in rapid changes in clinical manifestations. How to distinguish the difference between necrotizing fasciitis and cellulitis symptoms, in addition to observing the clinical symptoms and medical history inquiries, but also need imaging evidence, as soon as possible to diagnose and appropriate treatment, reduce its complications (such as multiple organ failure or Amputation) and reduce mortality!