Headley Adrienne J
Department of Family Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08901, USA.
Am Fam Physician. 2003 Jul 15;68(2):323-8.
Patients with necrotizing soft tissue infections often present initially to family physicians. These infections must be detected and treated rapidly to prevent loss of limb or a fatal outcome. Unfortunately, necrotizing soft tissue infections have no pathognomonic signs. Patients may present with some evidence of cellulitis, vesicles, bullae, edema, crepitus, erythema, and fever. They also may complain of pain that seems out of proportion to the physical findings; as the infection progresses, their pain may decrease. Magnetic resonance imaging and laboratory findings such as acidosis, anemia, electrolyte abnormalities, coagulopathy, and an elevated white blood cell count may provide clues to the diagnosis. No single organism or combination of organisms is consistently responsible for necrotizing soft tissue infections. Most infections are polymicrobial, with both anaerobic and aerobic bacteria frequently present. Fungal infections also have been reported. Generally, bacterial and toxin-related effects converge to cause skin necrosis, shock, and multisystem organ failure. Aggressive debridement of infected tissues is critical to management. Antimicrobial therapy is important but remains secondary to the removal of diseased and necrotic tissues.
坏死性软组织感染患者最初常就诊于家庭医生。必须迅速检测并治疗这些感染，以防止肢体丧失或出现致命后果。不幸的是，坏死性软组织感染没有特征性体征。患者可能表现出蜂窝织炎、水疱、大疱、水肿、捻发音、红斑和发热的一些迹象。他们也可能主诉疼痛，而疼痛程度似乎与体格检查结果不符；随着感染进展，疼痛可能减轻。磁共振成像以及酸中毒、贫血、电解质异常、凝血病和白细胞计数升高等实验室检查结果可能为诊断提供线索。没有单一的一种或一组微生物始终是坏死性软组织感染的病因。大多数感染是多微生物感染，常同时存在厌氧菌和好氧菌。真菌感染也有报道。一般来说，细菌和毒素相关作用共同导致皮肤坏死、休克和多系统器官衰竭。对感染组织进行积极清创对于治疗至关重要。抗菌治疗很重要，但相对于清除病变和坏死组织来说仍是次要的。
