- 期刊
台東地區壞死性肌膜炎六十例之經驗
Necrotizing Fasciitis: Experience with 60 Cases in Taitung, Taiwan
摘要
壞死性肌膜炎在臨床上是少見而嚴重的軟組織感染症，迅速使肌膜及皮下組織壞死為其特徵。其臨床表現並無特異性，早期症狀可以類似蜂窩性組織炎，而後進展迅速，若未早期診斷及積極手術治療，可在數小時或數天內死亡。台東地區因對外交通不夠便利，本院又為最後一線後送醫院，病患在發生急性重病時，多送往本院求治。故本院壞死性肌膜炎病例，可代表台東地區壞死性肌膜炎之概況。本文收集最近7年內，在本院經手術確定診斷之60位病例。共有49位男性及11位女性納入本研究。潛在疾病以酒癮28位(46.7%)及肝硬化22位(36.7%)最多。主要培養的菌枺為S.aureus反streptococcal spp.。我們記錄病患性別、年齡、過去疾史、外傷或手術病史、臨床症狀、血液生化資料等，並統計和預後的關係。結果只入院時是否有休克(p=0.007)及是否有腎功能不全史(p=0.007)和預後有相關。我們進一步將病患分存活組(45人)及非存活組(15人)，比較兩組在年紀，血液生化檢驗數值，發病至手術的時間，及就醫至手術的時間是否有差異。發現年紀(p=0.028)、白血球計數(p=0.027)、血小板數(p=0.046)及血清肌氨酸酐值(p=0.012)在兩組統計上有差異。
並列摘要
Necrotizing fasciitis (NF) is an uncommon, devastating, and life-threatening soft-tissue infection char-acterized by rapidly widely spreading necrosis of the fascia and subcutaneous tissues. The initial presenta-tions of NF are nonspecific. NF may initially resemble benign, low-grade cellulites that progresses rapidly and may be fatal within several hours to a few days unless early aggressive surgical clearance is instituted. Taitung located on the southeastern coast of Taiwan is somewhat remote from other cities in Taiwan. The majority of severely ill patients in Taitung are sent to the Taitung Branch of Mackay Memori-al Hospital. Hence, clinical presentations of necrotizing fasciitis in our hospital may represent the general feature of NF in Taiutng. We collected 60 cases surgically diagnosed in our hospital within the past 7 years. There were 49 men and 11 women included in this study. The most common underlying disease was alcoholism (28 cases), followed by liver cirrhosis (22 cases ). The predominant organisms cultured were Staphylococcus aureus and streptococcal species. We studied the correlation between the prognosis and some factors such as gender, age, underlying diseases, trauma history, operative history, clinical manifestations, laboratory data on admission, etc. Only shock on admission (p=0.007) and renal insufficiency history (p=0.007) correlated with a poor prognosis. We divide patients into two groups: 45 patients were in survival group and 15 patients were in non-surviving group. We tried to find the differences between these two groups with respect to age , hemogram, biochemisty, duration from onset of disease to redeiving surgical treatment, and duration from admission to receiving surgical treatment. Parameters with a signif-icant difference between these two groups were age (p=0.028), leukocytosis (p=0.027), thrombocytopenia (p=0.046), and serum creatinine level (p=0.012).