下肢壞死性筋膜炎：病例報告及文獻回顧

Necrotizing Fasciitis in Lower Extremity: A Case Report and Review of the Literature

簡建龍(Jiann-Long Jean) ； 張志鴻(Jhi-Hong Chang) ； 謝時鵬(Shih-Peng Hsieh) ； 唐秀蘭(Hsiou-Lan Tang) ； 陳泰昌(Tai-Chang Chern) ； 羅忠雄 ； 陳仁生(Jen-Sheng Cheng) ； 李心白(Hsin-Pai Lee)

《中華民國急救加護醫學會雜誌》 11卷4期 (2000/12) Pp. 163-168

https://doi.org/10.30018/JECCM.200012.0005

摘要

壞死性筋膜炎是一個很少，但非常嚴重的感染，其主要侵犯皮下組織筋膜及魯肪層。這種病假如延誤診斷及治療，常有致命的危險。此症主要好發於四肢、軀幹及會陰部。早期診斷並不是那麼容易，因初期症狀常和蜂窩組織炎相似，故誤診率很高。此篇病例報告主要描述一位65歲男性，罹患糖連病20餘年，規則服用降血糖藥物，於入院前3天漸有左側大腿近膝部及小腿部位紅腫熱又疼痛感，曾求助於診所，以一般蜂窩組織炎治病，口服抗生素後仍無效，症狀加劇。於入院當天前2小時，因合併有高燒，故送至本院急診室，經緊急筋膜切開術及重覆清創手術，另給序廣效靜脈抗生素注射及高熱量營養支持性治療，但仍於住院後3天後因合併多處器官衰竭而死亡。本文主要以病例報告及文獻回顧方式，提醒讀者對此症提高警覺。

關鍵字

壞死性筋膜炎 ； 蜂窩組織炎 ； 筋膜切開術 ； 清創

並列摘要

Necrotizing fasciitis (NF) is a rare, severe infection in the subcutaneous fascia and fat. It is life-threatening if treatment is delayed. It mainly occurs in the extremity, trunk and perineum. Early recongni-tion is difficult. Missed diagnosis as cellulites is common due to the initial clinical manifestation is atypi-cal. Many risk factors might contribute to the initial clinical manifestation is atypi-cal. Many risk factors might contribute to the rapid downhill clinical course of this disease. Here, we present a 65-year-old male, underlying disease of Non-Insulin-Dependent Diabetes Mellitus (NIDDM), suffered from his left lower extremity with NF, treated as cellulites at a local clinics and delayed the diagnosis and management. He was expired at our hospital in despite of aggressive management. We emphasize the importance of high index of suspicion of this disease if pain is out of proportion to physical findings. Early fasciotomy, aggressive surgical debridement, broad-spectrum intravenous antibiotics and adequate nutritional support may improve the outcome of NF.

並列關鍵字

necrotizing fasciitis ； cellulitis ； fasciotomy ； debridement