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頁籤選單縮合
題名 | 壞死性筋膜炎的治療經驗 |
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作者 | 李俊達; 簡守信; | 書刊名 | 慈濟醫學 |
卷期 | 6:4 1994.12[民83.12] |
頁次 | 頁257-264 |
分類號 | 416.15 |
關鍵詞 | 壞死性筋膜炎; 清創; Necrotizing fascitis; Immediate and aggressive debridement; |
語文 | 中文(Chinese) |
中文摘要 | 壞死性筋膜炎是皮下組織及筋膜的嚴重感染及壞死。雖然目前治療方法 有很大的進步,但它仍有很高的死亡率。這是因為:一、不易早期診斷。二、未 能及早徹底清創。三、常合併有其他兔疫能力減退之全身性疾病。本文報告慈濟 醫院從民國79年7月到83年6月,四年間28例壞死性筋膜炎的治療經驗。男性17 例,女性11例。年齡從29歲到74歲,平均54歲。病龜以下肢19例最多,上肢5例, 會陰3例,背部1例。71合併有其他疾病,以糖尿病最多,其次是動脈硬化、痛風 及肝硬化。許多病人都是病情嚴重才求診.包括7例敗血性休克。我們的治療原 則是:一、早期積極而徹底的清創。二、給予廣效性抗生素。三、一般支持性療 法包括輸液的補充,酸鹼電解質的平衡,充足的營養等。四、傷口的覆蓋。我們 共有3例病人死亡,死亡率為11,2例病人接受膝下截肢手術.治療結果還算令人 滿意。我們再度強調早期診斷及徹底清創的重要性。(慈濟醫學1994;6:257-264) |
英文摘要 | Necrotizing fascitis is a serious soft tissue infection characterized by rapidly spreading necrosis of fasciaand subcutaneous tissue. Despite the recent advancement in antimicrobial therapy and surgical techniques, thisdisease still carries a high rate of mortality. Twenty-eight cases of necrotizing fascitis treated at Buddhist Tzu-Chi General Hospital from July 1990through June 1994 are reviewed. There were 17 men and 11 women, ranging in age from 29 to 74 years (mean'54 years). Twenty-four patients had extremity lesions, 19 upper and 5 lower. Three infections involved theperineum and one patient had lesions on the lower back, buttock, and posterior thigh. Twenty patients (71)had associated chronic diseases such as diabetes mellitus, atherosclerosis, gout, liver cirrhosis, chronic renalfailure, and asthma etc. The common clinic manifestations were cellulitis, leukocytosis, and fever. Seven patients (25) presented with septic shock. Nineteen patients (68) had mixed infection. The predominant organisms were Staphylococcus aureus. Streptococcus, Proteus, and Escherichia coli. Anaerobes were cultured onlyin eight patients (29) with Bacteroid fragilis being the most common. Our regimen of treatment consisted ofvigorous resuscitation, immediate and aggressive surgical debridernent, broad spectrum antibiotics and nutritional support. A satisfactory result was achieved with only three deaths(mortality rate 11) and two B-Kamputations in our patients. We emphasize the importance of early diagnosis and treatment to further reduce themorbidity and mortality. (Tzu-Chi Med J 1994; 6: 257-264) |
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