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題名 | Necrotizing Fasciitis in the Cirrhosis of Liver Patients: What Else Should We Know beyond Fasciectomy?=壞死性筋膜炎在肝硬化病人:除了筋膜切除術,我們還知道什麼? |
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作者 | 林穎聖; 楊國強; 徐圭璋; 劉文忠; 林政達; 陳錦時; 陳理維; Lin, Ying-sheng; Yang, Kuo-chung; Hsu, Kuei-chang; Liu, Wen-chung; Lin, Cheng-ta; Chen, Jin-shyr; Chen, Lee-wei; |
期刊 | 臺灣整形外科醫學會雜誌 |
出版日期 | 20151200 |
卷期 | 24:4 2015.12[民104.12] |
頁次 | 頁316-326 |
分類號 | 416.15 |
語文 | eng |
關鍵詞 | 肝硬化; 壞死性筋膜炎; 筋膜切除術; Necrotizing fasciitis; Cirrhosis of liver; MELD; Child score; Mortality; |
中文摘要 | 背景:肝硬化在台灣是一個相對常見的疾病,肝硬化的病人往往比較容易遭受細菌感染。壞死性筋膜炎是一個少見但是會危及生命的疾病,通常會需要筋膜切除術。對整外醫師而言,除了施行筋膜切除術,對於病人的預後,我們能否給病人或家屬一個精確而且有證據力的答案?甚至,我們能否預測壞死性筋膜炎在此類病人的發生?目的及目標:探討是否可以預測壞死性筋膜炎在肝硬化病人的預後或是發生時機。材料及方法:總共回溯性分析五十五位病人。使用邏輯回歸(logistic regression)分析去找出跟死亡率相關的預測因子。在我們的病人資料庫中,有二十七位病人發生壞死性筋膜炎時同時被診斷有肝硬化,另外二十八位病人是先被診斷有肝硬化一段時間後才感染壞死性筋膜炎。我們使用Cox regression和Kaplan–Meier method去找出決定這段時間長短的因子。結果:MELD score跟死亡率有顯著相關(p=0.006)。Child score(p=0.001)和糖尿病與否(p=0.001)跟壞死性筋膜炎發生的時間有顯著相關。結論:壞死性筋膜炎發生在肝硬化病人時,Child score和病人是否有糖尿病與壞死性筋膜炎發生的時間點有相關。MELD score與死亡率有相關。 |
英文摘要 | Background: Cirrhosis of liver (COL) is a relatively common disease in Taiwanese patients, and the cirrhotic patients are prone to bacterial infections. Necrotizing fasciitis is a rare but life-threatening disease. Fasciectomy is almost always required. For plastic surgeons, besides performing fasciectomy, can we give the patients or their family a more precise and evidence-based answer to the prognosis? Furthermore, can we predict the timing of occurrence? Aim and Objectives We aimed to investigate whether we can predict the prognosis or timing of occurrence of necrotizing fasciitis (NF) in cirrhotic patients. Materials and Methods: Fifty-five patients were retrospectively analyzed. Logistic regression was conducted to determine contributing factors to mortality. In our database, forty-nine percent of the patients were presented with NF and COL at the same time. The remaining fifty-one percent of the patients were found to have NF after being diagnosed with COL for a period. Cox regression and Kaplan-Meier methods were used to examine the deciding factors for the length of this period. Results: Model for End-Stage Liver Disease (MELD) score (odds ratio=1.2, 95% confidence interval (CI): 1.06-1.37, p=0.006) is a statistically significant predictor of mortality. Child score (hazard ratio=4.84, 95% CI: 1.95-11.97, p=0.001) and diabetes mellitus (DM; hazard ratio=5.78, 95% CI: 2.01–16.6, p=0.001) are statistically significant factors affecting the timing of the occurrence of NF. Conclusions: In cirrhotic patients with NF, DM and Child score determine the timing of the occurrence of NF, and MELD score affects mortality rates. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。