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坏死性筋膜炎中坏死性筋膜炎实验室风险指标(LRINEC)评分的潜在预后意义

The Potential Prognostic Significance of the Laboratory Risk Indicator for the Necrotizing Fasciitis (LRINEC) Score in Necrotizing Fasciitis.

作者信息

Gönüllü Doğan, Ilgun Ahmet Serkan, Demiray Okan, Sayar Samed, Er Ahmet Muzaffer, Kır Gulay, Koksoy Ferda Nihat

出版信息

Chirurgia (Bucur). 2019 May-Jun;114(3):376-383. doi: 10.21614/chirurgia.114.3.376.

Abstract

We discuss the role of Laboratory Risk Indicator for the Necrotizing Fasciitis (LRINEC) on the prognosis of this disease. Necrotizing Fasciitis (NF) is characterised by rapid spreading of infection and necrosis of the soft tissues and fascia. Thirty patients (17 male, 13 female, mean age 57.5 years) were treated between 2011- 2016 (in our center); they were analysed retrospectively regarding age, sex, isolated microbiological agents, modalities of treatment and mortality rate. The majority of the infections were detected in the perineum (14 patients). Other sites of infection were: the presacral region (3 patients), as well as abdominal region after elective (10 patients) and emergency surgery (2 patients), respectively. 53.3% of patients had at least one predisposing comorbid factor such as diabetes mellitus, hypertension, cardiomyopathy and congestive heart failure. The tissue cultures were positive in 12 patients. Mean LRINEC score on admission was 8.5 +-2.85. There was a strong correlation between LRINEC score and patient age (p=0.018, R=0.43). LRINEC score was affected by neither gender nor the presence of any comorbidities. The patients were classified according to Wang and Wong staging system, as follows: one patient in stage 1, 15 patients in stage 2 and 14 patients in stage 3. Patients with higher Wang and Wong stages had significantly higher LRINEC scores. The mortality rate was 16.7%. The mean LRINEC score of deceased patients compared to patients who were successfully treated was 9.2Â+-2.2 and 8.36Â+-2.9. Conclusion: Even though LRINEC score and Wang and Wong stage were significatly related with ICU stay, their direct effect on mortality wasn't significant in our study.

摘要

我们探讨坏死性筋膜炎实验室风险指标(LRINEC)对该疾病预后的作用。坏死性筋膜炎(NF)的特征是感染迅速扩散以及软组织和筋膜坏死。2011年至2016年期间(在我们中心)对30例患者(17例男性,13例女性,平均年龄57.5岁)进行了治疗;对他们的年龄、性别、分离出的微生物病原体、治疗方式和死亡率进行了回顾性分析。大多数感染发生在会阴部位(14例患者)。其他感染部位分别为:骶前区域(3例患者),以及择期手术后(10例患者)和急诊手术后(2例患者)的腹部区域。53.3%的患者至少有一种易感合并症,如糖尿病、高血压、心肌病和充血性心力衰竭。12例患者的组织培养呈阳性。入院时LRINEC评分的平均值为8.5±2.85。LRINEC评分与患者年龄之间存在强相关性(p = 0.018,R = 0.43)。LRINEC评分不受性别或任何合并症的影响。根据王和黄分期系统对患者进行分类,如下:1期1例患者,2期15例患者,3期14例患者。王和黄分期较高的患者LRINEC评分显著更高。死亡率为16.7%。与成功治疗的患者相比,死亡患者的LRINEC评分平均值分别为9.2±2.2和8.36±2.9。结论:尽管LRINEC评分以及王和黄分期与重症监护病房住院时间显著相关,但在我们的研究中,它们对死亡率的直接影响并不显著。

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