Creta Massimiliano, Longo Nicola, Arcaniolo Davide, Giannella Riccardo, Cai Tommaso, Cicalese Annarita, De Nunzio Cosimo, Grimaldi Giovanni, Cicalese Virgilio, De Sio Marco, Autorino Riccardo, Lima Estevao, Fedelini Paolo, Marmo Mariano, Capece Marco, La Rocca Roberto, Tubaro Andrea, Imbimbo Ciro, Mirone Vincenzo, Fusco Ferdinando
Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Naples, Italy.
Unit of Urology, Luigi Vanvitelli University of Campania, Naples, Italy.
Minerva Urol Nefrol. 2020 Apr;72(2):223-228. doi: 10.23736/S0393-2249.20.03696-6. Epub 2020 Feb 19.
Evidence about the clinical benefits of Hyperbaric Oxygen Therapy (HBOT) in patients with Fournier's Gangrene (FG) is controversial and inconclusive. We aimed to compare the mortality related to FG between patients undergoing surgical debridement and/or standard antibiotic therapy alone or in combination with HBOT.
We performed a retrospective multi-institutional observational case-control study. All patients admitted with diagnosis of FG from June 2009 to June 2019 were included into the study. Patients received surgical debridement and/or standard antibiotic therapy alone or in combination with HBOT. Factors associated with FG related mortality were assessed with uni-and multivariate analyses. The main outcome measure was FG related mortality.
A total of 161 patients with diagnosis of FG were identified. Mean FG Severity Index was 8.6±4.5. All patients had broad-spectrum parenteral antibiotic therapy. An aggressive debridement was performed in 139 (86.3%) patients. A total of 72 patients (44.7%) underwent HBOT. Mortality due to FG was observed in 32 (36.0%) of patients who do not underwent HBOT and in 14 (19.4%) of patients who underwent HBOT (P=0.01). At the multivariate analysis, surgical debridement and HBOT were independent predictors of lower mortality while higher FG Severity Index was independent predictor of higher mortality.
HBOT and surgical debridement are independent predictors of reduced FG related mortality.
关于高压氧疗法（HBOT）对福尼尔坏疽（FG）患者临床益处的证据存在争议且尚无定论。我们旨在比较单纯接受手术清创和/或标准抗生素治疗的患者与接受上述治疗并联合HBOT的患者中与FG相关的死亡率。
我们进行了一项回顾性多机构观察性病例对照研究。纳入了2009年6月至2019年6月期间所有诊断为FG的住院患者。患者单纯接受手术清创和/或标准抗生素治疗，或接受上述治疗并联合HBOT。通过单因素和多因素分析评估与FG相关死亡率的相关因素。主要结局指标是与FG相关的死亡率。
共确定了161例诊断为FG的患者。FG严重程度指数平均为8.6±4.5。所有患者均接受了广谱肠外抗生素治疗。139例（86.3%）患者进行了积极的清创术。共有72例患者（44.7%）接受了HBOT。未接受HBOT的患者中有32例（36.0%）因FG死亡，接受HBOT的患者中有14例（19.4%）因FG死亡（P=0.01）。在多因素分析中，手术清创和HBOT是较低死亡率的独立预测因素，而较高的FG严重程度指数是较高死亡率的独立预测因素。
HBOT和手术清创是降低FG相关死亡率的独立预测因素。
