Brown D L, Greenhalgh D G, Warden G D
Shriners Burns Institute and Department of Surgery, the University of Cincinnati, Ohio 45229, USA.
J Burn Care Rehabil. 1998 Mar-Apr;19(2):119-23.
Victims of purpura fulminans are overcome by a rapidly progressive and sometimes fatal course involving large amounts of tissue loss and multiple organ system failure. From 1986 to 1995, seven children ranging in age from 10 months to 19 years (mean, 6.2 years) were referred to the Shriners Burns Institute in Cincinnati with purpura fulminans. Neisseria meningitidis was identified as the precipitating pathogen in most of the patients. The mean TBSA full-thickness skin loss was 33%. Fourteen extremities were amputated in the seven patients, including three patients with amputations of all four extremities. Transfer to our institution occurred after a mean delay of 20 days, usually after the demarcation of viable tissue. In one patient, however, fasciotomies obviated multiple impending amputations. Monitoring for elevated compartment pressures, early fasciotomies, and expedient transfer to a burn center for a multidiciplinary approach to care should improve the outcome in patients with purpura fulminans.
暴发性紫癜患者会经历快速进展且有时致命的病程，包括大量组织损失和多器官系统衰竭。1986年至1995年期间，7名年龄在10个月至19岁（平均6.2岁）的儿童因暴发性紫癜被转诊至辛辛那提的施赖纳烧伤研究所。大多数患者中，脑膜炎奈瑟菌被确定为促发病原体。平均全层皮肤烧伤面积为33%。这7名患者中有14条肢体被截肢，其中3名患者四肢均被截肢。患者平均延迟20天后转至我院，通常是在存活组织分界后。然而，有1名患者通过筋膜切开术避免了多次即将进行的截肢手术。监测筋膜间隙压力升高情况、早期进行筋膜切开术以及迅速转至烧伤中心采用多学科护理方法，应能改善暴发性紫癜患者的预后。
