- 期刊
Idiopathic Necrotizing Fasciitis: Clinical Presentation, Microbiology, Risk Factors and Determinants of Mortality
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
摘要
壞死性筋膜炎的早期診斷與治療，是存活與否的基本關鍵。原發性壞死性筋膜炎，因爲沒有明顯已知的致病因素，亦找不到致病菌入侵的入口，使得其診斷更具挑戰性。本研究在於找出原發性壞死性筋膜炎中有利於早期診斷的臨床特徵，及與死亡相關的決定因子。我們收集自87年7月至95年6月間，共185個經外科手術確定診斷的壞死性筋膜炎案例，予以回溯性研究。將這些案例分爲原發性及次發性兩組，分析比較兩組的臨床表徵、致病因素及其罹病因素、致病病原體及臨床預後。結果收集的185個壞死性筋膜炎案例中有115個(62.2%)爲原發性。相對於次發性壞死性筋膜炎而言，原發性壞死性筋膜炎的特徵爲：併發有糖尿病或慢性腎功能不足者，較少發燒，較少有水疱形成。與死亡相關的因子爲：入院時有休克，腎功能不足，麩胺酸草醋酸轉化酶升高者。兩組死亡率並無差異。所以，對於不可解釋的軟組織疼痛或壓痛，即使沒有典型的癥狀，仍應考慮原發性壞死性筋膜炎的可能。
關鍵字
無資料並列摘要
Early recognition and treatment of necrotizing fasciitis (NF) is essential for survival. Idiopathic NF occurs in the absence of a known causative factor or portal of entry for bacteria, so it may not be considered immediately when patients are admitted. This study aimed to identify specific features of idiopathic NF that are important for early recognition and to assess factors associated with mortality. The records of 185 patients with surgically confirmed necrotizing fasciitis between January 1998 and June 2006 were retrospectively reviewed. The infection was classified as either idiopathic or secondary NF, and the clinical presentation, etiology, predisposing factors, microbiology, and outcome of the two groups were compared. Idiopathic NF occurred in 115 of 185 patients (62.2%). Patients with idiopathic NF were more like than those with secondary NF to have diabetes mellitus or chronic renal insufficiency, and they were less likely to have fever or skin bullae. Significant predictors of death in patients with idiopathic NF were shock on admission, impaired renal function, and elevated aspartate aminotransferase. Mortality did not differ significantly between idiopathic and secondary NF. Idiopathic NF should be considered as a cause of unexplained soft tissue pain and tenderness, even in the absence of typical signs of this infection.
延伸閱讀
- Wu, C. J., Wei, L. G., Chang, T. I., Chen, C. F., Wang, H. J., & Chiu, W. K. (2016). 嚴重抗藥性金黃色葡萄球菌感染同時造成壞死性筋膜炎以及感染性心內膜炎之治療. 臺灣整形外科醫學會雜誌, 25(3), 251-257. https://www.airitilibrary.com/Article/Detail?DocID=a0000593-201609-201610120017-201610120017-251-257
- Hung, W. C., Lin, H. C., Huang, C. H., Yang, S. Y., & Jeng, C. H. (2005). 創傷弧菌感染導致下肢壞死性筋膜炎－病例報告及文獻回顧. 中華民國整形外科醫學會雜誌, 14(4), 363-371. https://doi.org/10.7096/JPSA.200512.0363
- Cheng, N. C., Horng, S. Y., Chang, S. C., & Tang, Y. B. (2004). Aeromonas hydrophila院內感染引起之壞死性筋膜炎. Journal of the Formosan Medical Association, 103(1), 53-57. https://doi.org/10.29828/JFMA.200401.0009
- Hung, M. H., Su, B. A., Lin, Y. S., Liu, C., Chen, C. C., Yeh, C. C., Chao, W. N., & Huang, K. F. (2014). 產氣單胞菌引起的壞死性筋膜炎－奇美醫學中心的病例分析. 臺灣整形外科醫學會雜誌, 23(2), 149-160. https://www.airitilibrary.com/Article/Detail?DocID=a0000593-201406-201407070025-201407070025-149-160
- 朱愛玲（2016）。壞死性筋膜炎病人發生率、醫療資源耗用及死亡率之探討〔碩士論文，高雄醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0011-2107201623451700