Janane A, Hajji F, Ismail T O, Chafiqui J, Ghadouane M, Ameur A, Abbar M, Albouzidi A
Departamento de Urología, Hospital Militar Universitario, Facultad de Medicina Mohamed V, Rabat, Marruecos.
Actas Urol Esp. 2011 Jun;35(6):332-8. doi: 10.1016/j.acuro.2011.01.019. Epub 2011 Apr 14.
Hyperbaric oxygen therapy (HBOT) concomitant to surgery has been reported to reduce Fournier's gangrene (FG) mortality compared to exclusive surgical debridement. Most report from centers with relatively few patients using only surgical procedure. To assess efficiency of aggressive debridement with adjunctive HBOT. To evaluate Fournier's gangrene severity score index (FGSI) predictive value.
70 Fournier's gangrene (FG) treated by surgical debridement and HBOT. Data were evaluated physical examination findings, admission and final laboratory tests, surgical debridement extent, and antibiotic used. Patients had adjunctive (HBOT). FGSI, developed to assign a score describing the acuity of disease, was used. This index presents patients' vital signs, metabolic parameters (sodium, potassium, creatinine, and bicarbonate levels, and white blood cell count) and computes a score relating to the severity of disease at that time. Data were assessed according to whether the patient survived or died. All patients underwent surgical debridement. Wound debridement was regularly performed in the post operative period.
Of 70 patients, 8 died (11.4%) and 62 survived (88.5%). Difference in age between survivors (median age, 50.0 yr) and non survivors (median age, 54.5 yr) was not significant (p=0.321). Median extent of body surface area involved in necrotizing process in patients who survived and did not survive was 2.4% and 4.9%, respectively (p=0.001). Except for albumin, no significant differences were found between survivors and nonsurvivors. Median admission FGSI scores for survivors and non survivors were 2.1±2.0 and 4.2±3.8, (p=0.331).
FGSI score did not predict disease severity and the patient's survival. Metabolic aberrations, extent of disease seemed to be important risk factors for predicting FG severity and patient survival.
与单纯手术清创相比，据报道手术联合高压氧治疗（HBOT）可降低福尼尔坏疽（FG）的死亡率。大多数报告来自患者相对较少且仅采用手术治疗的中心。目的是评估积极清创联合辅助性HBOT的疗效。评估福尼尔坏疽严重程度评分指数（FGSI）的预测价值。
70例福尼尔坏疽（FG）患者接受了手术清创和HBOT治疗。对体格检查结果、入院及最终实验室检查、手术清创范围和使用的抗生素进行数据评估。患者接受了辅助性（HBOT）治疗。使用了FGSI，其用于给出描述疾病严重程度的评分。该指数呈现患者的生命体征、代谢参数（钠、钾、肌酐和碳酸氢盐水平以及白细胞计数），并计算出与当时疾病严重程度相关的评分。根据患者存活或死亡情况评估数据。所有患者均接受了手术清创。术后定期进行伤口清创。
70例患者中，8例死亡（11.4%），62例存活（88.5%）。存活者（中位年龄50.0岁）与非存活者（中位年龄54.5岁）的年龄差异无统计学意义（p = 0.321）。存活和未存活患者坏死过程累及的体表面积中位数分别为2.4%和4.9%（p = 0.001）。除白蛋白外，存活者与非存活者之间未发现显著差异。存活者和非存活者入院时的FGSI中位数分别为2.1±2.0和4.2±3.8（p = 0.331）。
FGSI评分不能预测疾病严重程度和患者存活情况。代谢异常、疾病范围似乎是预测FG严重程度和患者存活的重要危险因素。
