Wattel F, Gosselin B, Chopin C, Durocher A, Crasquin O, Beaucaire G
Ann Anesthesiol Fr. 1977;18(10):825-30.
On the basis of 47 cases of gas gangrene collected over the three year period between 1974 and 1976, the authors review the circumstances surrounding its development, the clinical features and the prognosis of the disorder which remains grave despite a well-defined therapeutic protocol combining surgery, antibiotics and hyperbaric oxygen. There would appear to be a real resurgence of the disease at the present time. Post-traumatic and surgical aetiologies predominate, giving rise to two types of gangrene: clostridial gas gangrene secondary to contamined wounds, with a quasi-constant vascular element, affecting predominantly the limbs, and nonclostridrial gangrene, the increasing prevalence of which involves essentially spetic abdomino-pelvic surgery. In the light of this study, prognosis would appear to be related to the underlying terrain in which the gangrene occurs, to certain features of the clinical picture and, above all, to the possibilities of early application of the complete therapeutic protocol. Strict prophylactic measures would alone seem capable of preventign the worrying increase in the number of cases of gas gangrene.
作者根据1974年至1976年三年间收集的47例气性坏疽病例,回顾了该病发生的相关情况、临床特征以及预后。尽管有明确的综合手术、抗生素和高压氧的治疗方案,但该病的预后仍然严重。目前看来这种疾病确实有复发的情况。创伤后和手术病因占主导,引发了两种类型的坏疽:因伤口污染继发的梭状芽孢杆菌性气性坏疽,几乎都有血管因素,主要影响四肢;以及非梭状芽孢杆菌性坏疽,其发病率不断上升,主要涉及脓毒性腹部盆腔手术。根据这项研究,预后似乎与坏疽发生的基础状况、临床表现的某些特征,尤其是与早期应用完整治疗方案的可能性有关。似乎只有严格的预防措施才能阻止气性坏疽病例数量令人担忧的增加。