Mohammedi I, Ceruse P, Duperret S, Vedrinne J, Boulétreau P
Department of Intensive Care and Hyperbaric Medicine, Pavillon N, Edouard Herriot Hospital, Place d'Arsonval, F-69 003 Lyon, France.
Intensive Care Med. 1999 Aug;25(8):829-34. doi: 10.1007/s001340050959.
To evaluate clinical and microbiologic characteristics, modalities of treatment and outcome of patients with cervical necrotizing fasciitis admitted to our institution.
Retrospective clinical investigation.
We reviewed the charts of 20 consecutive patients hospitalized in our Intensive Care Unit between January 1987 and June 1998 with the diagnosis of cervical necrotizing fasciitis.
All the patients required mechanical ventilation. Four of them had mediastinal involvement. The organisms most commonly implicated included Streptococcus, Prevotella, and Peptostreptococcus species. Patients with adequate surgery had a better outcome than those with inadequate surgical procedures. Because no evidence-based recommendations exist in the field of head and neck infections, hyperbaric oxygen was not used as adjunctive therapy. Of the 20 patients, 3 (15 %) died.
The main finding of this study is that prompt, rather than delayed, surgical débridement correlates with a decrease in morbidity and mortality. However, no definite conclusion is justified due to the relatively small number of patients. Immediate radical débridement, and early redébridement if needed, appropriate antibiotics and intensive care support are critical in controlling these life-threatening infections.
评估我院收治的颈部坏死性筋膜炎患者的临床及微生物学特征、治疗方式及预后。
回顾性临床研究。
我们回顾了1987年1月至1998年6月期间连续入住我院重症监护病房的20例诊断为颈部坏死性筋膜炎患者的病历。
所有患者均需机械通气。其中4例有纵隔受累。最常涉及的病原体包括链球菌、普雷沃菌属和消化链球菌属。手术充分的患者比手术不充分的患者预后更好。由于头颈部感染领域尚无循证推荐，高压氧未用作辅助治疗。20例患者中，3例（15%）死亡。
本研究的主要发现是，及时而非延迟的手术清创与发病率和死亡率的降低相关。然而，由于患者数量相对较少，尚无明确结论。立即进行根治性清创，必要时早期再次清创、使用适当的抗生素及重症监护支持对于控制这些危及生命的感染至关重要。
