Hyperbaric Oxygen Therapy in Extensive Fournier's Gangrene-our Experience of Treatment

高壓氧治療應用於廣泛性的Fournier's壞疽

洪明嬋(Ming-Chran Hung) ； 潘慕嵩(Mu-Song Pan) ； 鄭立勤(Li-Chin Cheng) ； 田宇峯(Yu-Feng Tian) ； 周家麟(Chia-Lin Chou)

《中華民國大腸直腸外科醫學會雜誌》 25卷1期 (2014/03) Pp. 16-20

https://doi.org/10.6312/SCRSTW.2014.25(1).10216

摘要

Fournier's壞疽是位於會陰部及肛門附近爆發性的壞死性筋膜炎，且是一種高度致命的疾病。致病菌使皮下細小動脈產生閉鎖性內膜炎，造成了血流灌注不足狀態，進而發展成其附近皮膚及筋膜之壞疽。致病菌在此壞死的皮膚及筋膜中會迅速增生，造成皮膚及筋膜的嚴重感染及敗血症。廣泛性的Fournier's壞疽比局限性的Fournier's壞疽有較高的死亡率。年老，外傷，糖尿病，免疫抑制和慢性全身性疾病是誘發因素。敗血症是造成病患死亡最重要的因素。Fournier's壞疽的治療原則包括消除病原和阻斷廣泛性 Fournier's壞疽的進展。消除病原包含廣效性之抗生素治療、患處儘早而徹底的清創，引流和經常的換藥處理。阻止壞死性筋膜炎的進展可以通過增加組織氧合作用。高壓氧治療可增加血液含氧量，改善組織缺氧，因而改善預後。但是，高壓氧治療的臨床效果尚有爭議的。我們提出高壓氧治療應用在廣泛性Fournier's壞疽的臨床經驗。

關鍵字

筋膜切開術 ； 福耳尼埃氏壞疽 ； 高壓氧 ； 壞死性筋膜炎

並列摘要

Fournier's gangrene is a fulminant necrotizing fasciitis of the perineum and a lethal disease. Obliterative endarteritis, caused by the pathogens, blocks the circulation, impairs tissue perfusion, and then causes gangrene and necrosis of the skin and fascia. The pathogens rapidly proliferate along the necrotic fascia and skin, leading to serious infection and sepsis. The mortality rate of patients with Fournier's gangrene with extensive lesions is higher than that for patients with localized lesions. Old age, trauma, diabetes, immunosuppression, and chronic systemic diseases are predisposing factors. Sepsis is the most important factor of mortality. The principles of treatment include eradicating the bacteria and blocking the progress of extensive Fournier's gangrene. Eradication of bacteria includes use of broad-spectrum antibiotics, wound debridement, drainage and frequent dressing changes. Blockage of the progress of necrotizing fasciitis can be done by increasing tissue oxygenation. Hyperbaric oxygen therapy is a good modality to increase tissue oxygen and, therefore, improves the outcome. However, the clinical effects of hyperbaric oxygen therapy are controversial. We present our clinical experience with hyperbaric oxygen therapy in extensive Fournier's gangrene.

並列關鍵字

Fasciotomy ； Fournier's gangrene ； Necrotizing fasciitis ； Hyperbaric oxygen