Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee, UK.
Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee, UK.
Eur J Vasc Endovasc Surg. 2015 May;49(5):593-9. doi: 10.1016/j.ejvs.2015.02.002. Epub 2015 Mar 21.
To assess the short and long-term outcomes of necrotizing soft tissue infection (NSTI) in intravenous drug users (IVDU) in a regional vascular centre.
This was a retrospective analysis of all IVDUs with NSTI admitted to the regional vascular surgical unit between January 2009 and July 2014. Clinical outcome measures were interval between admission and surgery, length of ITU/HDU and hospital stays, post-operative complications, in hospital and one year mortality.
25 patients were admitted. The median age was 39 years (range 30-53 years) with a female to male ratio of 1:3.3. The median interval between admission and surgery was 23 hours (range 2-195 hours), however, this was significantly less when the admitting specialty was directly to vascular surgery (median 4 hours, range 2-7) compared with other specialties (median 38 hours, range 7-195 hours). Ten patients required HDU/ITU care with a median duration of 4 days (range 1-12 days). Five patients (20%) required amputation, of whom two (40%) had a prosthetic limb fitted. There was one in hospital death (4%). Another patient died while awaiting limb fitting 4 months post discharge, giving a 1 year mortality of 8%.
NSTI in IVDUs carries high risk of amputation with a very low rate of limb fitting. Intervention is significantly delayed when the admitting specialty is not vascular surgery, and half of these patients require HDU/ITU care, with significant morbidity and mortality. Early diagnosis and referral to vascular surgery is crucial in management of these patients.
评估区域性血管中心静脉药物使用者（IVDU）中坏死性软组织感染（NSTI）的短期和长期结果。
这是对 2009 年 1 月至 2014 年 7 月期间在区域性血管外科病房住院的所有 NSTI 静脉药物使用者进行的回顾性分析。临床结果评估包括入院和手术之间的间隔、重症监护病房/高依赖病房和住院时间、术后并发症、住院期间和 1 年死亡率。
共收治 25 例患者。患者年龄中位数为 39 岁（范围 30-53 岁），女性与男性的比例为 1:3.3。入院与手术之间的中位数时间为 23 小时（范围 2-195 小时），但当收治科室为血管外科时，这一时间明显缩短（中位数 4 小时，范围 2-7 小时），而其他科室为（中位数 38 小时，范围 7-195 小时）。10 例患者需要在重症监护病房/高依赖病房接受治疗，中位时间为 4 天（范围 1-12 天）。5 例患者（20%）需要截肢，其中 2 例（40%）安装了假肢。住院期间有 1 例死亡（4%）。另有 1 例患者在出院后 4 个月等待安装假肢时死亡，1 年死亡率为 8%。
静脉药物使用者的 NSTI 具有很高的截肢风险，而安装假肢的比例非常低。如果收治科室不是血管外科，干预措施会明显延迟，且其中一半患者需要重症监护病房/高依赖病房治疗，导致发病率和死亡率都很高。早期诊断和向血管外科转诊对这些患者的治疗至关重要。
