Fournier坏疽患者易患因素和并发症与病死率的分析

Analysis of predisposing factors or complications and mortality in patients with Fournier's gangrene

目的分析Fournier坏疽患者的易患因素、并发症和病死率的关系。方法收集2002~2013年我院接诊的58例Fournier坏疽患者的临床资料。回顾两组患者年龄、性别、易患因素、并发症、临床和实验室资料、病死率等,分析易患因素和并发症对病死率的影响,对预后相关因素进行统计分析。结果高病死率见于糖尿病（12/24,50.00%）,心功能不全（10/18,55.56%）,脓毒血症（15/29,51.72%）,血流动力学不稳定（15/31,48.39%）,血钠降低（14/15,93.33%）,肌肉受累（11/12,91.67%）,腹壁感染（14/22,63.64%）。生存组与死亡组比较,以下方面显示出明显的统计学差异：年龄[（42.5±2.1）岁vs.（63.2±2.8）岁,P〈0.001],脓毒症状态（93.75%vs.33.33%,P〈0.001）,血流动力学不稳定（93.75%vs.38.10%,P〈0.001）,血钠降低（87.50%vs.23.81%,P〈0.001）,肌肉受累（68.75%vs.2.38%,P〈0.001）,腹壁感染（87.50%vs.19.00%,P〈0.001）,糖尿病（75.00%vs.28.57%,P〈0.05）。肌酸激酶增高[（393.23±4.81）U/L vs.（512.57±6.35）U/L,t=91.60,P〈0.001],乳酸增高[（2.41±1.12）mmol/L vs.（10.83±2.34）mmol/L,t=20.49,P〈0.001],抗凝血酶Ⅲ降低[（62.85±5.20）%vs.（47.72±3.98）%,t=11.58,P〈0.001],也是明显的死亡预后因素。结论 Fournier坏疽具有病死率高的特点,在处理该类患者时,需严密监测并控制易患因素,积极对症处理预后相关的并发症,综合治疗,才能降低病死率。

Objective To determine predisposing factors or complications and mortality of patients with Fournier＇s gangrene. Methods Data of 58 Foumier＇s gangrene patients （treated in our hospital from 2002 to 2013） were evaluated retrospectively. Data of age gender, predisposing factors, complication, clinical and laboratory findings and mortality were collected retrospectively. To analyse the effect of predisposing factors and complications to mortality rates. Results An increase in the mortality could be seen in patients with diabetes mellitus （12/24, 50.00%）, cardiac insufficiency （10/18, 55.56%）, a septic condition at presentation （15/29, 51.72%）, hemodynamic instability （15/31, 48.39%）, low serum sodium levels （14/15, 93.33%）, muscular involvement （11/12, 91.67%）, and the abdomen was affected （14/22, 63.64%）. The comparison between the survivors and the nonsurvivors showed a statistical significance for the factor age [（42.5±2.1） years vs. （63.2±2.8） years, P〈0.001], a septic condition at presentation （93.75% vs. 33.33%, P〈0.001）, hemodynamic instability （93.75% vs. 38.10%, P〈0.001）, low serum sodium levels （87.50% vs. 23.81%, P〈0.001）, muscular involvement （68.75% vs. 2.38%, P〈0.001） and abdominal affection （87.50% vs. 19.00%, P〈0.001）, diabetes mellitus （75.00% vs. 28.57%, P〈0.05）. The increase of creatine kinasc[（393123±4.81）U/L vs. （512.57±6.35）U/L, t=91.60, P〈0.001] and lactate [（2.41±1.12）mmol/L vs. （10.83±2.34）mmol/L, t=20.49, P〈0.001] as well as a decrease of the antithromhin III parameter[（62.855.20）% vs. （47.72±3.98）%, t=1 1.58, P〈0.001] also proved to be a significant factor for a fatal prognosis. Conclusion Foumier＇s gangrene is known to have a high mortality. It is important that discovering and controlling predisposing or complication to decrease the mortality.