Darke S G, King A M, Slack W K
Br J Surg. 1977 Feb;64(2):104-12. doi: 10.1002/bjs.1800640207.
The clinical features of gas gangrene and related infection seen in 88 patients over a 10-year period are described. It is suggested that clostridial infection could be simply classified as either 'gas-forming' or 'non-gas-forming'. The gas-forming group represents the more severe form of infection. Non-clostridial gas gangrene may present in a variety of forms. The anaerobic streptococcus was the organism most frequently responsible, but these cases were indistinguishable from clostridial infection on clinical grounds. The treatment of gas gangrene in this series of patients is reported. Emphasis is laid on the importance of adequate prophylaxis with penicillin in patients at risk. The value of antibiotics in established infection remains equivocal. The evidence supporting the value of hyperbaric oxygen therapy is assessed and an attempt made to quantify the response to this treatment. Benefit was apparent in only a proportion of patients. A favourable response indicated clostridial infection and guaranteed immediate survival. Extensive debridement or amputation is unnecessary in this group. No response following hyperbaric oxygen therapy indicated widespread mixed clostridial and non-clostridial infection, or infection due to organisms other than clostridia. Urgent and extensive debridement and amputation remain the predominant measures in this group.
本文描述了88例患者在10年期间出现的气性坏疽及相关感染的临床特征。建议梭菌感染可简单分为“产气型”或“非产气型”。产气型代表更严重的感染形式。非梭菌性气性坏疽可能有多种表现形式。厌氧链球菌是最常见的病原体，但这些病例在临床上与梭菌感染难以区分。本文报告了该系列患者气性坏疽的治疗情况。强调了对高危患者使用青霉素进行充分预防的重要性。抗生素在已确诊感染中的价值仍不明确。评估了支持高压氧治疗价值的证据，并尝试量化对该治疗的反应。仅一部分患者有明显获益。良好的反应表明为梭菌感染并保证立即存活。该组患者无需进行广泛的清创或截肢。高压氧治疗无反应表明存在广泛的梭菌和非梭菌混合感染，或由非梭菌病原体引起的感染。紧急和广泛的清创及截肢仍是该组的主要治疗措施。
