MODERN CONCEPTS OF THE DIAGNOSIS AND TREATMENT OF NECROTIZING FASCIITIS
MODERN CONCEPTS OF THE DIAGNOSIS AND TREATMENT OF NECROTIZING FASCIITIS
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DOI：
10.1016/j.jemermed.2008.06.024
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发表时间：
2010-08-01
影响因子：
1.5
通讯作者：
Long, William B., III
中科院分区：
文献类型：
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作者：
Edlich, Richard F.;Cross, Catherine L.;Long, William B., III
背景：坏死性筋膜炎是一种潜在致命的感染，涉及快速进展、广泛的浅筋膜坏死。目的：本次集体综述的目的是回顾坏死性筋膜炎的治疗和诊断的现代概念。讨论：坏死性筋膜炎的特点是皮下组织和筋膜广泛坏死。尽管坏死性筋膜炎的发病机制仍有待推测，但坏死性筋膜炎快速且具有破坏性的临床病程被认为是由于多细菌共生所致。在过去的二十年中，科学家发现坏死性筋膜炎的发病机制通常是多种微生物，而不是单一微生物。尽管尚未发表对照良好的临床试验来比较各种诊断成像方式在诊断坏死性感染方面的功效，但磁共振成像 (MRI) 是检测软组织感染的首选技术。 MRI 提供无与伦比的软组织对比度和空间分辨率，在检测软组织液方面具有高灵敏度，并具有多平面功能。建议经皮针吸，然后立即进行革兰氏染色和培养，以对软组织感染进行快速细菌学诊断。手术辅以抗生素是坏死性筋膜炎的主要治疗方法。结论：应该对所有可以通过轻柔的压力轻松从筋膜上提起的组织进行广泛的清创。据报道，静脉注射免疫球蛋白成功用于治疗链球菌中毒性休克综合征。使用高压氧疗法等辅助疗法治疗坏死性筋膜炎感染继续受到广泛关注。 (C) 2010 爱思唯尔公司。
Background: Necrotizing fasciitis is a potentially fatal infection involving rapidly progressive, widespread necrosis of the superficial fascia. Objectives: The purpose of this collective review is to review modern concepts of the treatment and diagnosis of necrotizing fasciitis. Discussion: Necrotizing fasciitis is characterized by widespread necrosis of the subcutaneous tissue and the fascia. Although the pathogenesis of necrotizing fasciitis is still open to speculation, the rapid and destructive clinical course of necrotizing fasciitis is thought to be due to multibacterial symbiosis. During the last two decades, scientists have found that the pathogenesis of necrotizing fasciitis is usually polymicrobial, rather than monomicrobial. Although there has been no published well-controlled, clinical trial comparing the efficacies of various diagnostic imaging modalities in the diagnosis of necrotizing infections, magnetic resonance imaging (MRI) is the preferred technique to detect soft tissue infection. MRI provides unsurpassed soft tissue contrast and spatial resolution, has high sensitivity in detecting soft tissue fluid, and has multiplanar capabilities. Percutaneous needle aspiration followed by prompt Gram's staining and culture for a rapid bacteriologic diagnosis in soft tissue infections is recommended. Surgery complemented by antibiotics is the primary treatment of necrotizing fasciitis. Conclusion: Wide, extensive debridement of all tissues that can be easily elevated off the fascia with gentle pressure should be undertaken. Successful use of intravenous immunoglobulin has been reported in the treatment of streptococcal toxic shock syndrome. The use of adjunctive therapies, such as hyperbaric oxygen therapy, for necrotizing fasciitis infection continues to receive much attention. (C) 2010 Elsevier Inc.