摘要
为了提高小儿急性坏死性筋膜炎的诊治水平。对３０例小儿急性坏死性筋膜炎进行了分析。仅３例有臀部肌注史（１０％），２６例病变部位在腰背及臀部（８６．７％）。１８例有长期仰卧史。致病菌为金黄色葡萄球菌、链球菌、大肠杆菌（脆弱杆菌）等混合感染。极早多处切开引流，二期反复清创，大量３％双氧水液冲洗以提高组织的氧化还原电位差（Ｅｈ）及选用高敏感的抗菌素和支持疗法是治疗的关键。２７例痊愈出院（９０％），２例皮肤缺损大行植皮术、随访无功能受限，１例筋膜广泛坏死致全身衰竭而自动放弃治疗。２例换药时重复菌培养发现继发性绿脓假单胞菌感染。病程最长４２天，最短１３天，平均２７．５天。发病原因及发病部位于成人不同，局部受压及患部污染是重要的致病因素，广泛性筋膜坏死毒素吸收及扩创打击易导致患儿全身衰竭。多种细菌协同作用所引起的小儿软组织感染应引起人们的重视。
Thirty infants of acute necrotic fascitis were admitted.Three cases had a history of intramuscular injection.The situs of 26 cases were in lumbodorsal and buttocks.The offending organism was a mixed infection of staphylococcus aureus,streptococcus,colibacillus or anaerobic bacillus(bactericides fragile).The treatment included early multiple incision and drainage,repeated debridement and irrigation with 3%hydrogen peroxide solution,antibiotics and support therapy.Among them,27 cases survived(90%),2 underwent skin grafting,one gave up treatment because of extensive shin necrosis and systemic exhaustion.The course was from 13 to 42 days withan average of 27.5 days.We consider that the etiology and location of necrotic fascitis in infancyare differnet from those in adults.Local compression and contamination are the main pathogenicfactors.Toxin absorption from extensive necrosis and debridernent may bring about systemic exhaustion.More attention should be paid to the rapidly progressive infection in infancy caused bythe coordination of various bacteria.
出处
《中华小儿外科杂志》
CSCD
1996年第4期237-239,共3页
Chinese Journal of Pediatric Surgery
