重症气性坏疽患者的临床特点分析

Analysis of the clinical characteristics of patients with severe gas gangrene

目的:收集气性坏疽病例的临床资料,总结临床特点及治疗经验,为临床诊治提供数据参考。方法:回顾2013年1月—2023年1月北京积水潭医院重症医学科收治的诊断为气性坏疽的患者,将患者分为感染性休克组及非感染性休克组,记录基本信息、入院实验室数据、病原学数据、临床预后和预测评分(LRINEC评分、SIARI评分和NAS评分)。结果:共纳入14例患者,死亡的3例(21.4%)患者早期均出现感染性休克。患者全部为男性;基础疾病包括高血压(3例)、糖尿病(2例)、冠心病(1例)、肾功能不全(1例)等;感染部位包括下肢8例(57.1%),会阴区及肛周2例(14.3%),手部1例(7.1%),骨盆区及骶尾部1例(7.1%),泌尿系1例(7.1%),腹部1例(7.1%)。12例(85.7%)患者粗大杆菌涂片阳性;4例(28.6%)患者的伤口分泌物培养出产气荚膜梭菌。感染性休克组早期APTT、PT、INR明显高于非感染性休克组(P<0.05)。ICU住院时间(P=0.176)和总住院天数(P=0.257)在2组间差异无统计学意义。感染性休克组的住院费用为(16.0±10.0)万元,显著高于无感染性休克组的(7.2±3.9)万元(P=0.048)。结论:气性坏疽早期诊断十分重要,LRINEC评分和粗大杆菌涂片是较为敏感的筛查手段,气性坏疽一旦进展为感染性休克,病死率及住院费用将明显增加。感染性休克组患者早期的凝血指标也明显较差。

Objective Collect clinical data of gas gangrene cases and summarize clinical characteristics and treatment experience to provide data reference for clinical diagnosis and treatment.Methods The patients diagnosed as gas gangrene in the Department of Intensive Care Unit of Beijing Jishuitan Hospital from January 2013 to January 2023 were divided into septic shock group and non-septic shock group. The basic information, admission laboratory data, pathogenic data, clinical prognosis, and prediction score(LRINEC score, SIARI score, NAS score) were recorded.Results A total of 14 patients were included. Three patients(21.4%) died of septic shock at the early stage. All patients were male. Basic diseases include hypertension(3 cases), diabetes(2 cases), coronary heart disease(1 case), renal insufficiency(1 case), etc. The infection sites included 8 cases(57.1%) of lower limbs, 2 cases(14.3%) of perineal region and perianal region, 1 case(7.1%) of hand, 1 case(7.1%) of pelvic region and sacrococcygeal region, 1 case(7.1%) of urinary system, and 1 case(7.1%) of abdomen. The early wound secretion smears from the 12(85.7%) patients with gas gangrene infection in the present study showed large gram-positive rods. Clostridium perfringens was cultured in the wound secretion of 4 patients(28.6%). The early APTT, PT and INR in septic shock group were significantly higher than those in non-septic shock group(P < 0.05). There was no significant difference between the two groups in the length of stay in ICU(P=0.176) and the total length of stay in hospital(P=0.257). The hospitalization cost of the septic shock group was(160 000±100 000) Yuan, significantly higher than(72 000±39 000) Yuan in the non-septic shock group(P=0.048).Conclusion The early diagnosis of gas gangrene is very important. LRINEC score and the early wound secretion smears are relatively sensitive screening methods. Once gas gangrene develops into septic shock, the mortality and hospitalization costs will increase significantly and the early coagulation indexes of patients with septic shock will be significantly worse.