罕见的多细菌协同感染致肢体坏疽一例

Extremity gangrene caused by rare co-infection of multiple bacteria: a case report

作者经治1例罕见的多细菌协同感染致肢体坏疽。患者于1994年11月15日因右手及前臂进行性感染坏死3个月,左中指感染坏死2个月入院。经3个月的多种抗生素、换药、右前臂坏死肢体截肢等治疗,坏死未能控制。经专家会诊后,采用加强全身支持疗法,应用广谱抗生素泰能,彻底清除坏死组织,坏死得以控制。1周后刨面肉芽组织新鲜,行断层植皮,3个月后创面愈合。左拇、示及小指保留,其功能正常;右前臂安装机械活动性假肢;痊愈出院。一次取左中指坏死残端近端1cm处深部组织,经多家医院分离培养,有需氧菌2种,专或兼性厌氧菌10种,目前有3种尚未确定名称。病理组织学特点为皮肤深层肌肉与骨间膜的慢性化脓性坏死性炎症伴有明显嗜酸性白细胞浸润。本例为罕见的多细菌协同感染引起的肢体进行性坏疽。以全身中毒症状较轻、局部由浅而深的进行性坏死,形成黑痂为特点。

Because of progressive infectious necrosis on right hand and forearm for 3 months and the necrosis on left mid-finger for 2 months, a girl patient,Yang Xiaoxia was admitted on 15th, Nov. 1994. Systemic intoxicative symptom was slight and the necrotic tissue presented black scar. After 3 months treatment by application of multiple antibiotics, local dressing changes and an amputation of right froearm,the necrosis could not be stopped but keeping deteriorating. Through experts' consulta-tion, systemic surpportive therapy, wide-spectrum antibiotics cilastatin sodium and complete debride-ment were adopted. One week later, the fresh surface of granulation tissue was seen,and skin grafting was performed. The wound healed 3 months later. After further rehablitation, the left thumb,index vnd fifth finger showed normal function. A mechanical motional artificial limb was installed on right forearm and discharged. The deep necrotic tissue of left mid-finger was examined. Results of culture from several hospital presented 2 kinds of aerobic bacteria and 10 kinds of the anaerobic, of which,the names of 3 kinds are still unknown. Pathological examination showed chronic pyogenic necrotic infec-tion ,spreading from skin to deep muscles and interosseous membrane. And infiltration of eosinopbilic granulocytes was found in the infectious region. Conclusion : This patients is progressive gangrene of the extremity caused by rare co-infection of multiple bacteria. The charecteristcs were slight systemic intox-icative symptom,local progressive necrosis and formation of black scar. By means of systemic surp-portive therapy, application of wide-spctrum antibiotics cilastatin sodium, complete debridement and skin grafting, the patient was cured.