- 期刊
壞死性筋膜炎的治療經驗
Experience in the Treatment of Necrotizing Fascitis
摘要
壞死性筋膜炎是皮下組織及筋膜的嚴重威染及壞死。雖目前治療方法有很大的進步，但它仍有很高的死亡率。這是因為：一、不易早期珍斷。二、未能及早徵底清創。三、常合併有其他免疫能力減退之全身性疾病。本文報告慈濟醫院從民國79年7月到83年6月，四年間28例壞死性筋膜炎的治療經驗。男性17例，女性11例。年齡從29歲到74歲，平均54歲。病以下肢19例最多，上肢5例，會陰3例，背部1例。71%合併有其化疾病，以糖尿病最多，其次是動脈硬化、痛風及肝硬化。許多病人都是病情嚴重才求診，包括7例敗血性休克。我們的治療原則是：一、早期積極而徵底的清創。二、給予廣效性抗生素。三、一般支持性療法包括輸液的補充，酸鹼電解質的平衡，充足的營養等。四、傷口的覆蓋。我們共有3例病人死亡，死亡率為11%，2例病人接受膝下截肢手術，治療結果還算令人滿意。我們再度強調早期診斷及徹底清創的重要性。(慈濟醫學 1994; 6: 257-264)
並列摘要
Necrotizing fascitis is a serious soft tissue infection characterized by rapidly spreading necrosis of fascia and subcutaneous tissue. Despite the recent advancement in antimicrobial therapy and surgical techniques, this disease still carries a high rate of mortaliy. Twenty-eight cases of necrotizing fascitis treated at Buddhist Tzu Chi General hospital from July 1990 through June 1994 are reviewed. There were 17 men and 11 women, ranging in age from 29 to 74 years (mean 54 years). Twenty-four patients had extremity lesions, 19 upper and 5 lower. Three infections involved the perineum and one patient had lesions on the lower back, buttock, and posterior thigh. Twenty patients (71%) had associated chronic diseases such as diabetes mellitus, atherosclerosis, gout, liver cirrhosis, chronic renal failure, and asthma etc. The common clinic manifestations were cellulites, leukocytosis, and fever,. Seven patients (25%) presented with septic shock. Nineteen patients (68%) had mixed infection. The predominant organ isms were Staphylococcus aureus, Streptococcus, Proteus, and Eschericahia coli. Anaerobes were cultured only in eight patients (29%) with Bacteroid fragilis being the most common. Our regimen of treatment consisted of vigorous resuscitation, immediate and aggressive surgical debridement, broad spectrum antibiotics and nutritional support. A satisfactory result was achieved with only three deaths (mortality rate 11%) and two B-K amputations in our patients. We emphasize the importance of early diagnosis and treatment to further reduce the morbidity and mortality.(Tzu-Chi Med J 1994; 6: 257-264)
延伸閱讀
- 柯文謙、莊銀清（1997）。摧膚毀筋的嚴重感染：壞死性筋膜炎。台灣醫學，1(1)，66-71。https://doi.org/10.6320/FJM.1997.1(1).11
- 洪明嬋、顏家聖、杜珠理、李凱莉、李亭婷、洪翊珊、田宇峯、趙建銘（2015）。壞死性肌膜炎的治療－病例報告。臺灣醫界，58(10)，17-19。https://www.airitilibrary.com/Article/Detail?DocID=17263603-201510-201510140015-201510140015-17-19
- Wang, P. C., Chen, C. C., Chiu, A. C., Su, S. C., & Chang, K. M. (2008). 原發性壞死性筋膜炎：臨床表徵，微生物學危險因子及死亡決定因素. 內科學誌, 19(4), 337-345. https://doi.org/10.6314/JIMT.2008.19(4).08
- Pan, C. H., Yu, C. M., Ou, S. Y., Tung, K. Y., Huang, W. C., Yu, C. M., Tsai, M. F., Yao, W. T., & Chen, Y. F. (2021). 藥物注射引發之廣泛性壞死性筋膜炎－病例報告與文獻回顧. 臺灣整形外科醫學會雜誌, 30(2), 95-100. https://www.airitilibrary.com/Article/Detail?DocID=a0000593-202106-202109090018-202109090018-95-100
- Chen, Y. T., Peng, C. Y., Lu, M. Y., & Chiu, Y. W. (2019). Oral necrotizing fasciitis of the buccal mucosa. 中山醫學雜誌, 30(2), 151-153. https://www.airitilibrary.com/Article/Detail?DocID=16803108-201912-202002040013-202002040013-151-153