探討我國沿海致命的職業病―海洋霍亂弧菌所引發的猛爆性壞死性筋膜炎及敗血症之治療分析

Survey of a Fatal, Coastal Disease: Vibrio Cholerae Necrotizing Fasciitis, Septicemia, and Analysis of Treatment

陳年慶(Nien-Ching Chen) ； 蔡燿鴻(Yao-Hung Tsai) ； 曾士賓(Shih-Bin Tseng) ； 林資凱(Tzu-Kai Lin) ； 吳佳聖(Jia-Sheng Wu)

《中華職業醫學雜誌》 15卷2期 (2008/03) Pp. 131-138

https://doi.org/10.30027/CJOM.200803.0005

摘要

Background: The professional faculty and emergency medicine physicians do not know with certainty whether those individuals who come in contact with sea water, either by occupation, recreation, or food consumption, and have a history of a flesh wound, are at risk for infection with Vibrio cholerae, and as a result, necrotizing fasciitis and septicemia. When is such a patient at a high risk for mortality? The current report addressed this question, which was previously not answered in the medical literature.
Methods: We retrospectively reviewed the records of seventeen patients (twelve males and five females) who had necrotizing fasciitis and sepsis caused by Vibrio spp.. All patients had a history of contact with seawater or raw seafood. Ten patients had a hepatic disease, such as hepatitis or cirrhosis, four patients had diabetes mellitus without hepatic disease, and two patients had chronic renal or adrenal insufficiency, also without hepatic disease.
Results: All seventeen patients underwent fasciotomy or limb amputation. Six patients (35%) died within two to twelve days of hospital admission, and eleven patients survived. Patients with a systolic blood pressure of ≤ 90 mm Hg and leukopenia in the emergency room had a significantly higher mortality rate (p＜0.05).
Conclusions: When patients have clinical findings and a history of contact with seawater or raw seafood, the diagnosis of Vibrio necrotizing fasciitis should be suspected. The treatment should begin as soon as possible, especially when the patient has symptoms of sepsis. Although emergency fasciotomy or limb amputation did not reduce the mortality rate in this series, in the face of symptoms of septicemia, treatment should be initiated as soon as possible to and include consultations with general and orthopedic surgeons.

關鍵字

海洋霍亂弧菌 ； 壞死性筋膜炎 ； 筋膜切開手術

並列摘要

Background: The professional faculty and emergency medicine physicians do not know with certainty whether those individuals who come in contact with sea water, either by occupation, recreation, or food consumption, and have a history of a flesh wound, are at risk for infection with Vibrio cholerae, and as a result, necrotizing fasciitis and septicemia. When is such a patient at a high risk for mortality? The current report addressed this question, which was previously not answered in the medical literature.
Methods: We retrospectively reviewed the records of seventeen patients (twelve males and five females) who had necrotizing fasciitis and sepsis caused by Vibrio spp.. All patients had a history of contact with seawater or raw seafood. Ten patients had a hepatic disease, such as hepatitis or cirrhosis, four patients had diabetes mellitus without hepatic disease, and two patients had chronic renal or adrenal insufficiency, also without hepatic disease.
Results: All seventeen patients underwent fasciotomy or limb amputation. Six patients (35%) died within two to twelve days of hospital admission, and eleven patients survived. Patients with a systolic blood pressure of ≤ 90 mm Hg and leukopenia in the emergency room had a significantly higher mortality rate (p＜0.05).
Conclusions: When patients have clinical findings and a history of contact with seawater or raw seafood, the diagnosis of Vibrio necrotizing fasciitis should be suspected. The treatment should begin as soon as possible, especially when the patient has symptoms of sepsis. Although emergency fasciotomy or limb amputation did not reduce the mortality rate in this series, in the face of symptoms of septicemia, treatment should be initiated as soon as possible to and include consultations with general and orthopedic surgeons.

並列關鍵字

Vibrio cholerae ； necrotizing fasciitis ； fasciotomy