Clinical Analysis Of Necrotizing Fasciitis In 84 Cases

Objective: To explore and summarize the clinical diagnosis and treatment of necrotizing fasciitis.Method: Review the clinical data of 84 patients with necrotizing fasciitis admitted to the First Affiliated Hospital of China Medical University from January 2011 to June 2018 including the sex and age of onset,risk factor,clinical manifestation,the result of laboratory examination and etiological examination,diagnosis,treatment and outcome of disease.Results: Among 84 patients in this group,68 patients were male,accounting for82.14%,15 patients were female,accounting for 17.86%,the median age was 55 years old.Diabetes mellitus is the most common risk factor for necrotizing fasciitis.Among 84 patients in this group,36 patients suffered from diabetes mellitus of different degrees,accounting for 42.86%.Perianal is the most common location of lesion in necrotizing fasciitis.Among 84 patients in this group,the location of lesions in 65 patients were located at perianal,.accounting for 77.38%.Among the 84 patients in this group,62 patients had higher white blood cell count and neutrophil proportion,5 patients had higher white blood cell count and normal neutrophil proportion,7 patients had normal white blood cell count and higher neutrophil proportion,10 patients had normal white blood cell count and neutrophil proportion.Lower serum albumin is the most common abnormality in laboratory examination.Among 84 patients in this group,albumin in 56 cases were lower than 30 g/L,accounting for 66.67%.Escherichia coli is the most common pathogen.Bacterial culture was carried out in 28 patients,Escherichia coli was found in 10 patients and Klebsiella pneumoniae was found in 4 patients.Other bacteria included Streptococcus viridans,Streptococcus pyogenes,Streptococcus mastitidis,Staphylococcus aureus,Enterococcus faecalis,Acinetobacter baumannii,Proteus vulgaris,Enterobacter cloacae,Pseudomonas aeruginosa,Enterococcus avium,Enterococcus faecium,Saccharomyces albicans and Burkholderia cepacia.81 patients underwent debridement and drainage after admission,of which 76 patients was discharged in stable condition,2 patients died of septic shock during hospitalization,1 patient died of hemorrhage of digestive tract during hospitalization,2 patients suffered MODS and wasdischarged after giving up further treatment.3 patients did not undergo debridement and drainage after admission,of which 2 patients had contraindication of operation and 1patient suffered MODS and was discharged after giving up further treatment.Conclusion:Necrotizing fasciitis can occur in all age,mainly in the middle-aged and elderly people,which is more common in men.Diabetes is the most common risk factor,perianal is the most common lesion site,and Escherichia coli is the most common pathogen.Patients are usually in critical condition with abnormal laboratory indicators such as blood routine,liver function and ions,and even suffer severe complications such as septic shock and multiple organ dysfunction syndrome.Necrotizing fasciitis is a critical surgical disease with rapid progress.Early diagnosis is the key to improve prognosis.The treatment principles are early debridement and drainage,application of broad-spectrum or sensitive antibiotics and systemic support therapy.