目前诊断和治疗坏死性筋膜炎的方法

Łukasz Ciulkiewicz, Paulina Kryszpin, Piotr Jachimowski, Maciej Pełka, Anna Kania, Justyna Fijałkowska
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摘要

简介坏死性筋膜炎是一种不常见但非常致命的细菌感染,其特点是筋膜和皮下脂肪组织广泛坏死。虽然初期症状与典型感染相似,但坏死性筋膜炎进展迅速,会引发急性期反应。高龄、长期患病、免疫力低下或酗酒者尤其容易患坏死性筋膜炎。为了降低死亡率,早期诊断和适当治疗是必不可少的。研究目的本研究旨在通过评估现有文献,概述坏死性筋膜炎的现代诊断策略和新兴治疗方案。 知识现状描述:主要诊断方法包括临床评估和手术探查,辅以用于快速诊断的新鲜冷冻切片和手指试验。诊断成像包括使用磁共振成像、计算机断层扫描和超声波。治疗主要以手术清创和抗生素治疗为主。具有潜在疗效的疗法包括低剂量放射治疗、高压氧治疗,以及在成功治疗后使用完整的鱼皮移植进行组织重建。新出现的方法包括针对全身炎症反应综合征、败血症诱发的凝血病和与危重病相关的皮质类固醇不足的治疗。 结论坏死性筋膜炎的治疗主要依靠传统方法。快速识别和正确治疗是降低死亡率的关键。认识到急性期反应在坏死性筋膜炎治疗中的重要性,为治疗干预带来了新的可能性。进一步的研究对于评估现有的坏死性筋膜炎治疗方法以及探索新的诊断和治疗方法至关重要。
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Current approach to diagnosing and treating necrotizing fasciitis
Introduction: Necrotizing fasciitis is an infrequent yet highly fatal bacterial infection characterized by widespread necrosis of fascia and subcutaneous fat tissue. Though initial symptoms resemble typical infection, necrotizing fasciitis progresses rapidly triggering acute phase response. Individuals with advanced age, chronically ill, immunocompromised, or abusing alcohol are especially susceptible to developing necrotizing fasciitis. In order to reduce mortality, early diagnosis and appropriate treatment are indispensable. Aim of the Study: Aim of this study is through evaluating existing literature to outline the contemporary diagnostic strategies and emerging therapy options for necrotizing fasciitis. Description of the State of Knowledge: Primary diagnostic methods involve clinical evaluation and surgical exploration, complemented by fresh frozen sections for rapid diagnosis and the finger test. Diagnostic imaging incorporates the use of magnetic resonance imaging, computed tomography and ultrasound. The treatment is mostly centered around surgical debridement and antibiotic therapy. Therapies that display potential efficacy include low-dose radiotherapy, hyperbaric oxygen therapy, and the use of intact fish skin grafts for tissue reconstruction after successful treatment. The emerging approach includes therapy targeting systemic inflammatory response syndrome, sepsis induced coagulopathy and critical illness related corticosteroid insufficiency.  Conclusions: The management of necrotizing fasciitis primarily depends on traditional methods. Fast identification and proper treatment are pivotal in reducing the mortality rate. Recognizing the significance of addressing the acute phase response in necrotizing fasciitis treatment introduces new possibilities for therapeutic interventions. Further research is vital to evaluate the existing approaches to necrotizing fasciitis management and explore new diagnoistic and therapeutic alternatives.
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