Temporizing surgical management improves outcome in patients with Vibrio necrotizing fasciitis complicated with septic shock on admission

doi:10.1016/j.burns.2013.08.012

科研成果详情

题名	Temporizing surgical management improves outcome in patients with Vibrio necrotizing fasciitis complicated with septic shock on admission
作者	Hong, Guang-Liang1; Dai, Xiao-Qin2; Lu, Cai-Jiao3; Liu, Jia-Ming4; Zhao, Guang-Ju1; Wu, Bin 1; Li, Meng-Fang1; Lu, Zhong-Qiu1
发表日期	2014-05
发表期刊	BURNS 影响因子和分区
语种	英语
原始文献类型	Article
关键词	Vibrio necrotizing fasciitis Septic shock Treatment Surgical strategy Incision and drainage Aggressive debridement
其他关键词	SOFT-TISSUE INFECTIONS ; PROGNOSTIC-FACTORS ; VULNIFICUS ; SEPSIS ; DIAGNOSIS
摘要	Background: Necrotizing fasciitis (NF) caused by Vibrio infection is one of the most fatal diseases, resulting in high morbidity and mortality. Early diagnosis and effective surgical intervention are the mainstays for better outcomes for affected patients. Currently, standard surgical management calls for prompt and aggressive debridement and amputation. However, due to its rapid progression and deterioration, 50-60% of Vibrio NF cases present with septic shock and multiple organ dysfunction on admission. These patients, who usually have many surgical contraindications, are unable to tolerate a prolonged aggressive surgical debridement. Therefore, determining the optimal surgical intervention for these particularly severe patients remains a formidable problem in emergency medicine. Methods: A retrospective study was conducted on patients who underwent surgery for Vibrio NF and septic shock on admission to the emergency room from April 2001 to October 2012. These patients received the same treatment protocol, with the exception of the initial surgical intervention strategy. Nineteen patients were treated with a temporizing strategy, which called for simple incisions and drainage under regional anesthesia, followed by complete debridement 24 h later. Another fifteen patients underwent aggressive surgical debridement during the first operative procedure. Basic demographics, laboratory results on admission, clinical course and outcomes were compared to assess the efficacy and safety of two initial surgical treatment methods: the temporizing strategy and the aggressive strategy. Results: Thirty-four patients were included in this study, and the average age was 51.65 years. Chronic liver disease was the most prevalent preexisting condition (50.00%) and the lower limbs were most commonly involved in infection (76.47%). In this patient population, 19 cases underwent surgery with a temporizing therapeutic strategy, while the remaining 15 cases were treated with an aggressive surgical strategy. There were no differences between the two groups with respect to demographics, severity of illness and laboratory data. Compared with those treated with the aggressive strategy, patients treated with the temporizing strategy had shorter operation time (40.79 +/- 16.61 vs. 102.00 +/- 18.97 min, p < 0.001), less bleeding (120.53 +/- 67.20 vs. 417.33 +/- 134.72 mL, p < 0.001), a reduced amount of intraoperatively administrated fluid (3144.70 +/- 554.71 vs. 1637.40 +/- 302.11 mL, p < 0.001), decreased maximum dose of dopamine (15.73 +/- 5.64 vs. 10.47 +/- 5.61 mu kg/min, p = 0.011) and noradrenaline (20.13 +/- 7.50 vs. 13.37 +/- 6.18 mu g/kg/min, p = 0.007), lower arterial lactate values at the end of surgery (5.56 +/- 1.99 vs. 8.66 +/- 3.25 mmol/L, p = 0.004), and, most importantly, lower mortality (26.32% vs. 60.00%, p = 0.048). All other treatment conditions, such as duration of vasopressor therapy, number of debridement procedures, rate of amputation, ICU length of stay and hospital length of stay, were the same for both groups. Conclusion: The temporizing strategy, with early initiation of simple incisions and drainage under regional anesthesia followed by complete debridement 24 h later, is more feasible and effective for patients with Vibrio NF complicated with septic shock, as compared with the aggressive surgical debridement strategy. (C) 2013 Elsevier Ltd and ISBI. All rights reserved.
资助项目	Key Construction Academic Subject of Zhejiang Province [11-CX26, 2012-XK-A28]; Key Discipline Construction project of Colleges and Universities in Zhejiang Province
出版者	ELSEVIER SCI LTD
出版地	OXFORD
ISSN	0305-4179
EISSN	1879-1409
卷号	40 期号:3 页码:446-454
DOI	10.1016/j.burns.2013.08.012
页数	9
WOS类目	Critical Care Medicine ; Dermatology ; Surgery
WOS研究方向	General & Internal Medicine ; Dermatology ; Surgery
WOS记录号	WOS:000333787500011
收录类别	SCIE ; PUBMED ; SCOPUS
URL	查看原文
PubMed ID	24138809
SCOPUSEID	2-s2.0-84896067760
通讯作者地址	[Lu, Zhong-Qiu]Department of Emergency Medicine, First Affiliated Hospital of Wenzhou Medical University,2 Fuxue Lane,China
Scopus学科分类	Surgery;Emergency Medicine;Critical Care and Intensive Care Medicine
引用统计	被引频次：15[WOS] [WOS记录] [WOS相关记录]
文献类型	期刊论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/11629
专题	附属第一医院仁济学院_环境与公共卫生学部
通讯作者	Lu, Zhong-Qiu
作者单位	1.Department of Emergency Medicine, First Affiliated Hospital of Wenzhou Medical University,2 Fuxue Lane,China; 2.Department of General Surgery, First Affiliated Hospital of Wenzhou Medical University,China; 3.Department of Burns Surgery, First Affiliated Hospital of Wenzhou Medical University,China; 4.School of Environmental Science and Public Health, Wenzhou Medical University,China
第一作者单位	附属第一医院
通讯作者单位	附属第一医院
第一作者的第一单位	附属第一医院
推荐引用方式 GB/T 7714	Hong, Guang-Liang,Dai, Xiao-Qin,Lu, Cai-Jiao,et al. Temporizing surgical management improves outcome in patients with Vibrio necrotizing fasciitis complicated with septic shock on admission[J]. BURNS,2014,40(3):446-454.
APA	Hong, Guang-Liang., Dai, Xiao-Qin., Lu, Cai-Jiao., Liu, Jia-Ming., Zhao, Guang-Ju., ... & Lu, Zhong-Qiu. (2014). Temporizing surgical management improves outcome in patients with Vibrio necrotizing fasciitis complicated with septic shock on admission. BURNS, 40(3), 446-454.
MLA	Hong, Guang-Liang,et al."Temporizing surgical management improves outcome in patients with Vibrio necrotizing fasciitis complicated with septic shock on admission".BURNS 40.3(2014):446-454.