Gawaziuk J P, Strazar R, Cristall N, Logsetty S
Manitoba Firefighters' Burn Unit, Health Sciences Centre, Winnipeg, Manitoba, Canada.
Department of Surgery, Section of Plastic Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
J Plast Reconstr Aesthet Surg. 2018 Jun;71(6):857-862. doi: 10.1016/j.bjps.2018.01.035. Epub 2018 Feb 14.
Necrotizing fasciitis (NF) is a debilitating soft tissue infection that results in disfiguring scars and often amputations. While mortality rates have improved, long-term outcomes in survivors of NF are poorly understood.
The objective of this study is to analyze the impact of NF on survivors' health-related quality of life (HRQoL) influenced by age, sex, comorbidities, %TBSA, and confidence with appearance.
We surveyed 56 adult patients with NF treated at either of two regional referral centers in Manitoba, Canada, between January 1, 2004, and December 31, 2014. Necrotizing soft tissue infections involving the fascial planes were identified during surgical debridement. HRQoL was measured by the Medical Outcomes Short Form-36. Derriford Appearance Scale-24, age, sex, comorbidities, and %TBSA were recorded, and group comparisons and stepwise regression models were developed for the mental and physical component scores separately.
Mean Mental Component Score (MCS) was 44.5 ± 14.3 and mean Physical Component Score (PCS) was 36.5 ± 11.5; both means were lower than the Canadian population norm of 50. Although stepwise linear regression analyses with block entry indicated influence from age, sex, and comorbid conditions for the MCS and PCS, the only factors that were statistically significant in the final models were confidence with appearance for the MCS and %TBSA for the PCS.
NF has long-term impact on mental and physical health-related quality of life. Distress regarding confidence with appearance affects mental quality of life, whereas the size of the injured area impacted physical quality of life. These findings can help guide targeted interventions that could potentially improve recovery from NF.
坏死性筋膜炎（NF）是一种使人虚弱的软组织感染，会导致毁容性瘢痕，且常需截肢。虽然死亡率有所改善，但NF幸存者的长期预后仍知之甚少。
本研究的目的是分析NF对幸存者健康相关生活质量（HRQoL）的影响，该影响受年龄、性别、合并症、体表面积百分比（%TBSA）以及对外表的自信程度影响。
我们对2004年1月1日至2014年12月31日期间在加拿大曼尼托巴省两个地区转诊中心之一接受治疗的56例成年NF患者进行了调查。在手术清创过程中识别出累及筋膜平面的坏死性软组织感染。采用医学结局简明36项量表测量HRQoL。记录德里福德外貌量表-24、年龄、性别、合并症和%TBSA，并分别针对心理和生理成分得分建立组间比较和逐步回归模型。
平均心理成分得分（MCS）为44.5±14.3，平均生理成分得分（PCS）为36.5±11.5；两个平均值均低于加拿大人群的正常水平50。尽管采用逐步线性回归分析和逐步纳入法显示年龄、性别和合并症对MCS和PCS有影响，但最终模型中唯一具有统计学意义的因素是MCS方面的对外表自信程度和PCS方面的%TBSA。
NF对心理和生理健康相关生活质量有长期影响。对外表自信程度的困扰影响心理生活质量，而受伤面积大小影响生理生活质量。这些发现有助于指导有针对性的干预措施，可能改善NF的康复情况。
