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胸壁坏死性筋膜炎:1例预后良好的罕见病例。

Necrotising fasciitis of the thoracic wall: a rare case with favourable outcome.

作者信息

Nemésio Rodrigo Athayde, Ruivo Ana, Monteiro Alexandre, Tralhão José Guilherme

机构信息

General Surgery Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Coimbra, Portugal

Clinica Universitária de Cirurgia, University of Coimbra Faculty of Medicine, Coimbra, Coimbra, Portugal.

出版信息

BMJ Case Rep. 2021 Mar 5;14(3):e238749. doi: 10.1136/bcr-2020-238749.

Abstract

Necrotising fasciitis (NF) is a severe infection of the subcutaneous tissue and fascia that can rapidly lead to sepsis and shock with high mortality rates. Its initial signs are often non-specific making it difficult for an early diagnosis to be reached. Nevertheless it is of the utmost importance to begin proper treatment including wide surgical debridement as soon as possible in order to avoid death. We present the case of a patient with NF of the thoracic wall which is a rare location for this disease but often associated with worse prognosis. Even though he progressed to septic shock within less than 24 hours of its presentation, due to early surgical management, aggressive resuscitation and intensive care support, he reached a favourable outcome. After three surgical revisions and 2 weeks in an intensive care unit, the patient was discharged from hospital 35 days after admission.

摘要

坏死性筋膜炎(NF)是一种皮下组织和筋膜的严重感染,可迅速导致败血症和休克,死亡率很高。其最初症状往往不具有特异性,很难早期诊断。然而,尽早开始包括广泛手术清创在内的恰当治疗以避免死亡至关重要。我们报告一例胸壁坏死性筋膜炎患者的病例,胸壁是该病的罕见发病部位,但通常预后较差。尽管他在出现症状后不到24小时就进展为感染性休克,但由于早期手术治疗、积极的复苏和重症监护支持,他取得了良好的预后。经过三次手术修正和在重症监护病房治疗2周后,患者入院35天后出院。

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