会阴部坏死性筋膜炎合并糖尿病的临床特点及治疗(附48例临床病例总结)

Clinical characteristics and treatment of perineum necrotizing fasciitis with diabetes mellitus(Report of 48 cases)

目的分析会阴部坏死性筋膜炎(NF)合并糖尿病的临床特点并总结其治疗方法。方法回顾性分析成都中医药大学附属医院2013–2017年期间收治的48例会阴部NF患者的临床资料,比较糖尿病和非糖尿病以及死亡和存活患者的临床特点、细菌培养结果及实验室指标如白细胞计数(WBC)、血小板(PLT)、C反应蛋白(CRP),血清钠离子(Na^+)、钾离子(K^+)、钙离子(Ca^(2+))及血糖水平。结果 48例患者中男28例,女20例;糖尿病患者29例,非糖尿病患者19例;细菌培养结果阳性36例,阴性12例;死亡10例,存活38例。(1)糖尿病和非糖尿病患者在性别、24 h内手术、入住ICU和死亡患者人数比例以及年龄、发病至入院时间和ICU住院时间比较差异均无统计学意义(P>0.05)。糖尿病组患者克雷伯菌感染率明显高于非糖尿病患者(P<0.05);2组患者入院后第1、3及7天的CRP、WBC、PLT、Ca^(2+)、Na^+、K^+水平比较差异均无统计学意义(P>0.05)。(2)死亡患者与存活患者的性别、24 h内手术比例以及年龄、发病至入院时间、ICU住院时间比较差异均无统计学意义(P>0.05),死亡患者中入住ICU人数比例明显高于存活患者(P<0.05);死亡患者和存活患者的细菌培养结果阳性率比较差异无统计学意义(P>0.05);存活患者入院后第1和3天时的PLT均明显高于死亡患者(P<0.05),其他实验室指标比较差异均无统计学意义(P>0.05)。结论 NF需要早诊断、尽早手术并进行多学科会诊,从而进行全方位的治疗;合并糖尿病的患者在早期经验性运用抗生素治疗时应考虑运用对克雷伯菌敏感的抗生素。

Objective To analyze clinical features and treatment of cases of perineum necrotizing fasciitis with diabetes. Methods The clinical data of 48 cases of perineum necrotizing fasciitis with diabetes were retrospectively collected in the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from 2013 to 2017. The clinical features, bacterial culture results, and laboratory indicators such as the white blood cell count(WBC), platelet(PLT), C reactive protein(CRP), serum sodium(Na^+), potassium(K^+), calcium(Ca2^+), and blood sugar(Glu) levels were compared between the diabetic patients and the non-diabetic patients and between the death and the survival. Results Among the48 cases, there were 29 cases of perineum necrotizing fasciitis with diabetes, 10 cases of death, 36 cases of positive results of bacterial culture.(1) Between the diabetic patients and the non-diabetic patients, the proportions of the gender, surgery within 24 h, staying the ICU, and death had no significant differences(P >0.05);the age, time from onset to admission, and staying time in the ICU had no significant differences too(P >0.05). The Klebsiella infection rate in the diabetic patients was significantly higher than that in the non-diabetic patients(P<0.05). There were no significant differences in the CRP,WBC, PLT, Ca^2+, Na^+, and K^+ levels between the diabetic patients and the non-diabetic patients on the 1st, the 3rd, and the7 th day of the admission(P >0.05).(2) The proportions of the gender and surgery within 24 h had no significant differences(P >0.05), but of staying the ICU had a significant difference(P<0.05) between the death and the survival;the age, the time from onset to admission, and staying time in the ICU had no significant differences(P >0.05). The positive rate of bacterial culture results had no significant difference between the death and the survival(P >0.05). Except for the PLT(P<0.05), there were no significant differences in the CRP, WBC, and Glu levels between the death and the survival on the1 st and 3rd day of the admission(P >0.05). Conclusions Early diagnosis, early operation, and multidisciplinary treatment are important in treatment of perineum necrotizing fasciitis. Antibiotics which are sensitive to Klebsiella when treated with early experimental use should be considered for patients with diabetes mellitus.