Retrospective Analysis Of Clinical Data Of Patients With Perianal Necrotizing Fasciitis

Objective:To retrospectively analyze the clinical data of inpatients with perianal necrotizing fasciitis to understand the clinical characteristics,treatment and prognosis of inpatients with perianal necrotizing fasciitis,and to explore the risk factors that affect the mortality of patients In order to guide the diagnosis and treatment of perianal necrotizing fasciitis better and reduce the mortality of patientsMethods:On the basis of reviewing the etiology,pathogenesis,diagnosis and treatment of Chinese and Western medicine for perianal necrotizing fasciitis,a retrospective research method was adopted,since January 2014 until April 2019,followed by collection and telephone follow-up to the clinical data of 106 patients with perianal necrotizing fasciitis admitted to the Anorectal Department of Nanjing Chinese Medicine Hospital,including general conditions,TCM syndrome types,medical history data,diagnosis and treatment,and their prognosis Statistical data was analyzed using SPSS23.0 software.Result:1.Clinical data(1)Gender and age:89 patients with perianal necrotizing fasciitis were male and 17 were female,with a male to female ratio of approximately 5.2:1.The average age of patients with perianal necrotizing fasciitis is 54.06±16.24,with the most age group being 50-59 years old;(2)Hometown:Jiangsu Province and neighboring Anhui Province have the most patients,accounting for 95.3%,one case each in Shandong,Inner Mongolia,Heilongjiang,Jiangxi,and Fujian;(3)Etiology and comorbidities:Only 3 patients had obvious etiology,and most patients had no obvious cause;comorbidities were diabetes(40.6%),hypertension(30.2%),liver disease(10.4%)and malignant tumors(5.7%)More common;(4)Types of TCM syndromes:wet and flaming hot card(30.2%),poison into the blood card(69.8%);(5)The scope of the lesion:the perianal and perineum(46.2%)are most involved,followed by more than two(34%);(6)Clinical manifestations:for patients with perianal necrotizing fasciitis,erythema(90.6%),swelling(100%),pain(100%)are more common among local symptoms;hypoproteinemia(80.2%),electrolyte disturbance(70.8%),fever(45.4)%)are more common among systemic symptoms;(7)Microbial distribution:21 cases of microbial culture showed a single microbial type,and 9 cases were negative;among the 21 cases of cultured microorganisms,Escherichia coli(38.1%)was the most common;(8)Treatment:surgical debridement and antibiotics are the principles.In addition,the whole body is treated with nutritional support and dialectic Chinese medicine for oral treatment,and local wounds are fumigated with Chinese medicine decoction,antibiotic rinse and external application.(9)Course of disease and length of hospitalization:The average course of patients with perianal necrotizing fasciitis is 9.66±6.75,and the average length of hospitalization is 15.48±12.58.2.Analysis of mortality factorsUnivariate analysis found that age,RBC,Hb,urea nitrogen,and the need to be transferred to ICU due to the disease may have an impact on the mortality of perianal necrotizing fasciitis;multivariate analysis found that urea nitrogen was abnormally elevated and required to be transferred to ICU due to the disease are independent risk factors for patient mortality.Conclusion:1.The general situation and clinical characteristics of patients with perianal necrotizing fasciitis in this study are basically consistent with domestic and foreign reports,but there are also certain differences,which may be related to different regions,ethnicities and sample sizes.The treatment is mainly surgery and antibiotics.In addition to symptomatic support treatment,Chinese medicine is used for oral application and fumigation and external application.2.It was found that some factors may have an impact on the mortality rate of perianal necrotizing fasciitis.During clinical treatment,monitoring these factors can further reduce mortality.