壞死性肌膜炎：病例報告及文獻回顧

Necrotizing Fasciitis: A Case Report and Review of the Literature

邱愛珍(Ai-Chen Chiu) ； 鍾嫈嫈(Jin-Jin Tjung) ； 王柏川(Po-Chuan Wang) ； 蘇世強(Shey-Chiang Su)

《台灣家庭醫學雜誌》 14卷4期 (2004/12) Pp. 205-215

https://doi.org/10.7023/TJFM.200412.0205

摘要

在此報告一例47歲男性病患，有糖尿病、酒癮、肥胖等多項危險因子，在右下肢輕微割傷之後，發展為典型的壞死性肌膜炎。此病例最終死於敗血性休克及多重器官衰竭。本文的目的，希望藉此病例提醒基層醫師，在面對類似蜂窩性組織炎的病患時，尤其是具高危險因子的病患時，將此症列入鑑別診斷。一旦病患有不典型蜂窩性組織炎的表現，如：(1)疼痛的程度及範圍遠超過皮膚表面受侵犯的範圍，(2)極明顯的腫脹，尤其是腫脹範圍超過皮膚發紅的範圍，(3)合併有嚴重的全身性毒症表現時，應將壞死性肌膜炎列入鑑別診斷，及早轉介或會診感染科及外科醫師，以確定診斷及介入治療。其治療成功的關鍵，在淤早期診斷、積極的外科手術清創及適當的抗生素，並給予良好的支持性治療。

並列摘要

We report 47-year-old man who had diabetes, alcoholism obesity. He developed a fatal necrotizing fasciitis after an minor cut on his right lower leg. He eventually died of septic shock and multiple organ failure. The purpose of this article is to remind primary care physicians to differentiate this potentially fatal infection from cellulitis. Early surgical referral of patients with atypical cellulitis is warranted, particularly when (1) pain is disproportionate to the observed area of involvement, (2) massive edema extends beyond the area of erythema, and (3) severe systemic toxicity is present. Early diagnosis, aggressive surgical debridement and appropriate antibiotic therapy are the cornerstones of therapy.

並列關鍵字

necrotizing fasciitis ； cellulites