RESUMO
The treatment of acute necrotizing fasciitis consists of early and aggressive incision and drainage, together with effective antibiotics and active organ support. On January 4th, 2018, a 50-year-old man admitted to intensive care unit (ICU) of Peking University Third Hospital was diagnosed with acute necrotizing fasciitis in the right lower extremity caused by group A Streptococcal infection complicated with multiple organ dysfunction. The disease progressed rapidly. The lesion rapidly spread from the right calf to the entire right lower limb and was associated with septic shock and multiple organ dysfunction within a few hours after admission. The treatment included surgical debridement and amputation of his right lower extremity, multiple antimicrobials combination therapy, gamma globulin-assisted anti-infection, anti-shock, bedside continuous hemofiltration and other comprehensive treatment. The patient was successfully cured. The key to successful treatment of this patient is that when the acute necrotizing fasciitis progresses rapidly, amputation should be done to debride the infected lesions, together with early empirical broad-spectrum antibiotics combination therapy and active organ function support treatment.
RESUMO
The treatment of acute necrotizing fasciitis consists of early and aggressive incision and drainage, together with effective antibiotics and active organ support. On January 4th, 2018, a 50-year-old man admitted to intensive care unit (ICU) of Peking University Third Hospital was diagnosed with acute necrotizing fasciitis in the right lower extremity caused by group A Streptococcal infection complicated with multiple organ dysfunction. The disease progressed rapidly. The lesion rapidly spread from the right calf to the entire right lower limb and was associated with septic shock and multiple organ dysfunction within a few hours after admission. The treatment included surgical debridement and amputation of his right lower extremity, multiple antimicrobials combination therapy, gamma globulin-assisted anti-infection, anti-shock, bedside continuous hemofiltration and other comprehensive treatment. The patient was successfully cured. The key to successful treatment of this patient is that when the acute necrotizing fasciitis progresses rapidly, amputation should be done to debride the infected lesions, together with early empirical broad-spectrum antibiotics combination therapy and active organ function support treatment.
RESUMO
Objective To investigate the effect of hyperbaric oxygen therapy on serum procalcitonin (PCT), white blood cells(WBC) and high-sensitivity C-reactive protein (hs-CRP) levels in children with necrotising fasciitis (NF) and its efficacy, and explore the diagnosis value of above indicators.Methods From March 2011 to June 2014,50 cases children with acute necrotic fasciitis treated in Children's Hospital of Hebei Province as study group,which were randomly divided into hyperbaric oxygen group (n =25) and routine group (n =25) .The routine group received the routine therapy of incision and drainage to clear the lesion, hyperbaric oxygen group received hyperbaric oxygen therapy on the basis of routine group,while 50 healthy children were selected as control group.The serum PCT, WBC, hs-CRP levels, efficacy, complications, death and hospitalization time were observed and compared.Results The serum PCT, WBC and hs-CRP levels pre-treatment in study group were higher than those in control group(P<0.05).The area under the ROC curve of PCT and hs-CRP was 1.000,respectively, and WBC was 0.804, there were significant difference between PCT and WBC (Z=5.250,P=0.000), between hs-CRP and WBC (Z=5.037,P=0.000).After treatment, the wounds of 23 case patients (92.00%) were cured in hyperbaric oxygen group, and 21 cases in routine group (84.00%) , there were no significant difference in cure rate between two groups.There were six cases(24.00%) of complications and one case (4.00%) of death in hyperbaric oxygen group,while nine cases (36.00%) of complications and two cases (8.00%) of death, there were no significant difference in complications rate and death rate between two groups.The hospitalization time in hyperbaric oxygen group was (39.17 ±6.73) d, which was significantly lower than (52.13 ±4.28) d in routine group(P<0.05).Conclusion PCT and hs-CRP have certain value in diagnosis of children with acute necrotizing fasciitis; incision and drainage combined with hyperbaric oxygen therapy has a better clinical effect in the treatment of children with acute necrotizing fasciitis.