Garssen Frank P, Goslings J Carel, Bouman Catherine S C, Beenen Ludo F, Visser Caroline E, de Jong Vincent M
Academisch Medisch Centrum, Afd. Chirurgie, Trauma Unit, Amsterdam, the Netherlands.
Ned Tijdschr Geneeskd. 2013;157(31):A6031.
Necrotising soft-tissue infections occur in the soft tissue compartment consisting of the dermis, subcutaneous tissue, superficial fascia (fascia of Scarpa), deep fascia and muscle. Although this severe and acutely life-threatening infection has a low incidence, both GPs and specialists will see a necrotizing soft-tissue infection more than once during their career. The mortality related to necrotising soft-tissue infections has been halved during the past 15 years from nearly 40 to 20% due to adequate treatment. Laboratory examination and X-ray findings could be of added value, but the gold standard remains biopsy of the fascia and Gram staining. Treatment consists of prompt volume resuscitation in case of sepsis, administration of broad spectrum antibiotics and surgical debridement; this debridement should be as skin-sparing as possible. The use of hyperbaric oxygen therapy has remained a controversial issue, unless a patient has gas gangrene, caused by Clostridium species. A multidisciplinary treatment and admission to a tertiary intensive care unit are indispensable for the treatment of a septic patient with necrotizing soft-tissue infection.
坏死性软组织感染发生于由真皮、皮下组织、浅筋膜（斯卡帕筋膜）、深筋膜和肌肉组成的软组织间隙。尽管这种严重且危及生命的感染发病率较低，但全科医生和专科医生在其职业生涯中都会不止一次遇到坏死性软组织感染病例。由于治疗得当，过去15年中，坏死性软组织感染的死亡率已从近40%降至20%，减半。实验室检查和X线检查结果可能有辅助价值，但金标准仍是筋膜活检和革兰氏染色。治疗包括在发生脓毒症时迅速进行容量复苏、给予广谱抗生素和手术清创；这种清创应尽可能保留皮肤。高压氧治疗的应用一直存在争议，除非患者患有由梭状芽孢杆菌属引起的气性坏疽。对于患有坏死性软组织感染的脓毒症患者，多学科治疗和入住三级重症监护病房是必不可少的。
