Francis K R, Lamaute H R, Davis J M, Pizzi W F
Catholic Medical Center of Brooklyn and Queens, Inc., Jamaica, NY 11432.
Am Surg. 1993 May;59(5):304-8.
The following risk factors, previously associated with necrotizing fasciitis, were identified in 25 consecutive patients: diabetes mellitus, intravenous drug abuse, age greater than 50, hypertension, and malnutrition/obesity. Additional data recorded included the duration of illness to the time of the first operative procedure, the type of procedure performed, the anatomic location of the infection, the etiology, culture reports, and leukocyte counts. The goal of this study was to determine whether the number of risk factors present in a patient was predictive of mortality. Six patients (24%) died and 19 patients survived. The nonsurvivors exhibited a significantly higher percentage of diabetes mellitus, 83 per cent versus 37 per cent (P = 0.047). Fifteen of 19 survivors (79%) and only one of six nonsurvivors (17%) had fewer than three risk factors (P = 0.006). In conclusion, more than three previously identified risk factors present in patients with necrotizing fasciitis were found to be predictive of a mortality rate of 50 per cent. The mainstay of treatment remains aggressive surgical intervention, broad-spectrum antibiotics, and nutrition support.
在连续25例患者中确定了以下先前与坏死性筋膜炎相关的危险因素：糖尿病、静脉药物滥用、年龄大于50岁、高血压以及营养不良/肥胖。记录的其他数据包括从发病到首次手术的病程、所施行的手术类型、感染的解剖部位、病因、培养报告以及白细胞计数。本研究的目的是确定患者存在的危险因素数量是否可预测死亡率。6例患者（24%）死亡，19例患者存活。死亡患者中糖尿病的比例显著更高，为83%，而存活患者中为37%（P = 0.047）。19例存活者中有15例（79%）且6例死亡者中仅1例（17%）的危险因素少于3个（P = 0.006）。总之，坏死性筋膜炎患者中存在超过3个先前确定的危险因素被发现可预测50%的死亡率。治疗的主要手段仍然是积极的手术干预、广谱抗生素以及营养支持。
