弧菌坏死性筋膜炎患者的临床特点及预后分析

Clinical features and prognosis of patients with vibrio necrotizing fasciitis

目的探讨弧菌坏死性筋膜炎患者临床特点、治疗及预后影响因素，为早期诊治及预后评估提供参考。方法回顾性分析1995年5月-2011年6月急诊救治的56例弧菌坏死性筋膜炎患者的临床资料，总结其临床特点及治疗，对比生存组与死亡组临床因素的差异，分析影响预后的可能因素。结果临床主要表现为发热（61％）、休克（84％）及脏器功能损害，其中肾功能受累最常见（88％），病死率达43％。肢体病变早期仅有局部肿胀、疼痛，皮肤瘀斑、张力性血疱、坏死、皮下捻发音等则是晚期征象。需要早期应用敏感药物、结合外科手术切开引流及内科支持的综合治疗方案。生存组与死亡组间症状出现至入院时间（P〈0．05）、肢体病变累及躯干（P〈0．01）、肌酸激酶水平（P〈0．05）、急诊切开引流（P〈0．01）等因素差异有统计学意义。结论快速进展的局部症状、体征和急剧恶化的病情是弧菌坏死性筋膜炎最突出的临床表现，延时就诊、局部病变严重、未能急诊手术可能是预后不良的因素。

Objective To investigate clinical features, treatments and prognostic factors of the patients with necrotizing fasciitis caused by vibrio infections and thus provide reference for the early treatment and prognostic assessment. Methods A retrospective analysis was conducted on clinical data of 56 patients with vibrio necrotizing fasciitis admitted to the emergency center of our hospital from May 1995 to June 2011. The clinical characteristics and treatments of the patients were summarized, and differences of clinical factors between the survival group and death group were compared. The possible influencing factors for prognosis were also analyzed. Results The main clinical manifestations included fever （61%） , shock （84%） and organ dysfunction, of which renal insufficiency （88%） was the most common, with case fatality of 43%. Early pathological changes of limbs were only local swelling and pain, while skin ecchymosis, tension blood blisters, necrosis and subcutaneous crepitation were the signs of advanced stage. Comprehensive treatment regime including early administration of sensitive antibiotics plus surgical incision and drainage and medicine support was given. A series of factors were significantly different between the survival and death groups including the duration from the presentation of symptoms to hospital admission （ P 〈 0.05 ） , limb lesions involving the trunk （ P 〈 0.01 ） , creatine kinase level （P 〈 0.05 ） , and emergency incision and drainage （P 〈 0.01 ）. Conclusions The most prominent clinical manifestations of vibrio necrotizing fasciitis are rapidly progressive local symptoms and signs, and sharp deterioration of systemic conditions. Delayed visiting, severe local lesions, and failure to emergency surgery may be the factors for poor prognosis.