Huang Kuo-Feng, Hung Min-Hsiang, Lin Yu-San, Lu Chin-Li, Liu Cheng, Chen Chun-Chia, Lee Yen-Hsun
Division of Plastic Surgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan.
J Trauma. 2011 Aug;71(2):467-73; discussion 473. doi: 10.1097/TA.0b013e318220d7fa.
Necrotizing fasciitis (NF), a life-threatening soft tissue infection, requires early diagnosis, prompt and repeated surgical intervention, and broad-spectrum antibiotic therapy. The aim of this study was to identify the independent predictors of mortality among patients with NF in Taiwan.
We retrospectively reviewed the medical records of all patients who were admitted to Chi-Mei Medical Center, Tainan, Taiwan, with a diagnosis of NF. The definitive diagnosis was confirmed by the surgical findings, including (1) dishwater or foul-smelling discharge, (2) presence of necrotic fascia or lack of fascial bleeding, and (3) lack of resistance of normally adherent muscular fascia to blunt dissection. To identify factors associated with mortality, variables including personal history and comorbidities, clinical symptoms and signs, laboratory data, and microbiological data were compared between survivors and nonsurvivors.
From January 2003 to December 2009, 472 patients treated for NF were included in the study. The overall mortality was 12.1% (n = 57) and the 30-day mortality was 11.0% (n = 52). Multivariate analysis revealed eight independent predictors of mortality for NF including liver cirrhosis, soft tissue air, Aeromonas infection, age older than 60 years, band polymorphonuclear neutrophils >10%, activated partial thromboplastin time >60 s, bacteremia, and serum creatinine >2 mg/dL.
We identified eight independent predictors of mortality that provided useful information on the severity of NF and guidance for treatment. Prospective studies are required to examine the fitness and sufficiency of these variables as effective predictors of NF mortality.
坏死性筋膜炎（NF）是一种危及生命的软组织感染，需要早期诊断、及时且反复的手术干预以及广谱抗生素治疗。本研究的目的是确定台湾NF患者死亡的独立预测因素。
我们回顾性分析了所有入住台湾台南奇美医学中心且诊断为NF的患者的病历。通过手术所见确诊，包括（1）洗肉水样或有恶臭的分泌物，（2）存在坏死筋膜或筋膜无出血，以及（3）正常附着的肌筋膜对钝性剥离无阻力。为确定与死亡相关的因素，对幸存者和非幸存者之间的个人史和合并症、临床症状和体征、实验室数据以及微生物学数据等变量进行了比较。
2003年1月至2009年12月，纳入472例接受NF治疗的患者。总体死亡率为12.1%（n = 57），30天死亡率为11.0%（n = 52）。多因素分析显示NF死亡的八个独立预测因素，包括肝硬化、软组织积气、气单胞菌感染、年龄大于60岁、杆状核多形核中性粒细胞>10%、活化部分凝血活酶时间>60秒、菌血症以及血清肌酐>2mg/dL。
我们确定了八个死亡的独立预测因素，这些因素为NF的严重程度提供了有用信息并指导治疗。需要进行前瞻性研究以检验这些变量作为NF死亡率有效预测指标的适用性和充分性。
