Riseman J A, Zamboni W A, Curtis A, Graham D R, Konrad H R, Ross D S
Memorial Medical Center, Southern Illinois University, Springfield.
Surgery. 1990 Nov;108(5):847-50.
Twenty-nine patients with necrotizing fasciitis were treated from 1980 to 1988. This study evaluates how the addition of hyperbaric oxygen (HBO) therapy to surgical treatment has affected mortality and the number of debridements required to achieve wound control in these patients. Two groups of patients were viewed: group 1 (n = 12) received surgical debridement and antibiotics only; group 2 (n = 17) received HBO (90 minutes at 2.5 atm, average 7.4 treatments) in addition to surgery and antibiotics. Both groups were similar in age, race, sex, wound bacteriology, and antimicrobial therapy. Body surface area affected was similar, however, perineal involvement was more common in group 2 (53%) than in group 1 (12%). The admitting conditions of patients in group 1 (non-HBO) were diabetic, 33%; white blood cell count more than 12,000, 50%; and shock, 8%. The admitting conditions of patients in group 2 (HBO) were diabetic, 47%; white blood cell count more than 12,000, 59%; and shock, 29%. Although group 2 patients receiving HBO were more seriously ill on admission, mortality was significantly lower (23%) compared to group 1 (66%) (p less than 0.02). In addition, only 1.2 debridements per group 2 patient were required to achieve wound control versus 3.3 debridements per group 1 patient (p less than 0.03). The addition of HBO therapy to the surgical and antimicrobial treatment of necrotizing fasciitis significantly reduced mortality and wound morbidity (number of debridements) in this study, especially among nonclostridial infections. We conclude that HBO should be used routinely in the treatment of necrotizing fasciitis.
1980年至1988年期间，对29例坏死性筋膜炎患者进行了治疗。本研究评估了在手术治疗基础上加用高压氧（HBO）疗法对这些患者死亡率以及实现伤口控制所需清创次数的影响。观察了两组患者：第1组（n = 12）仅接受手术清创和抗生素治疗；第2组（n = 17）除手术和抗生素外还接受了HBO治疗（2.5个大气压下90分钟，平均7.4次治疗）。两组患者在年龄、种族、性别、伤口细菌学和抗菌治疗方面相似。受影响的体表面积相似，然而，第2组（53%）会阴受累比第1组（12%）更常见。第1组（非HBO组）患者的入院情况为：糖尿病患者占33%；白细胞计数超过12,000的患者占50%；休克患者占8%。第2组（HBO组）患者的入院情况为：糖尿病患者占47%；白细胞计数超过12,000的患者占59%；休克患者占29%。尽管接受HBO治疗的第2组患者入院时病情更严重，但其死亡率（23%）显著低于第1组（66%）（p < 0.02）。此外，第2组患者实现伤口控制平均每组仅需1.2次清创，而第1组患者每组则需3.3次清创（p < 0.03）。在本研究中，在坏死性筋膜炎的手术和抗菌治疗基础上加用HBO疗法可显著降低死亡率和伤口发病率（清创次数），尤其是在非梭菌感染患者中。我们得出结论，HBO应常规用于坏死性筋膜炎的治疗。
