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女子扁桃体发炎多日 脖子上的肉被“吃”掉一大片

2017-09-07 10:57:10   中国青年网

当晚,浦立副主任医师立刻为患者行气管切开术及咽侧壁脓肿切开术,吸出较多的脓性分泌物,马女士情况好转,但第二天她的体温仍有上升。

医生查房发现患者颈胸部皮肤红肿加重,触摸有波动感,表示红肿部位皮下又有不少脓性物质,遂电话联系苏立众主任。

创口未缝合前,患者颈胸部被“吃”后留下的创口

这天是周日,苏主任听取汇报后,立即与浦立副主任医师一起赶回医院,进行颈胸部脓肿切开引流术,手术顺利。期间,经过病理、细菌培养等,最终确诊马女士为可怕的“食肉菌”感染,即坏死性筋膜炎!

按理,像马女士这样严重的病人,术后可送重症监护室。但考虑马女士家在农村,经济情况一般,为节省患者费用,专家承担着很大风险让她转入普通病房。医师护士们每日24小时密切对其观察病情,监测电解质,予以足量应用抗生素,并加强营养等对症处理。

时间一天天过去了,所幸检查结果一次比一次好。术后共复查B超4次及一次颈部CT,都提示脓肿逐渐消失,软组织肿胀减轻,其他情况也逐渐好转,症状逐步减轻。

出院前三天医生为马女士拔出胃管,气管套管及缝合切口,此时马女士已无呼吸困难,吞咽困难及发热等不适。苏立众分析,马女士颈深部多发脓肿,颈部坏死性筋膜炎可能是口咽部细菌感染所导致,诱因或与其疲劳熬夜,受凉感冒等导致全身免疫力下降的因素有关。

马女士与苏立众(右)及王强(左)合影留念 “食肉菌”感染死亡率达两成

苏立众介绍,坏死性筋膜炎是一种由细菌入侵皮下组织、筋膜(肌肉和肌肉之间,肌肉和皮肤之间的结缔组织)引起的急性坏死性软组织感染,以广泛而迅速的皮下组织和筋膜坏死为特征,多伴有全身或局部免疫功能损害,严重者会发生全身中毒性休克危及生命,死亡率达20%,并会造成残疾(截肢)。该疾较为少见,但近几年呈增多的趋势。

据相关资料,坏死性筋膜炎常为多种细菌的混合感染,它专“吃”脂肪和筋膜,如果不及时清除,细菌会从内部将患者“吃掉”,故又称“食肉菌”。临床表现为沿深浅筋膜播散的感染,在累及血管内形成血栓,引起相应皮下组织、皮肤和筋膜的坏死。

此疾可发生在全身各个部位,以四肢为多见,尤其是下肢;其次是会阴、颈部、面部、腹壁和背臀部等。儿童以臀部、腰部为主,成人则多见于腹部及会阴部。严重时受感染部位的内部组织完全暴露在体外,坏死部分形成凹陷,就像被“吃”过一样,十分恐怖。

医生还提醒有糖尿病,免疫力低下,营养不良,年老,静脉吸毒,长期应用糖皮质激素,慢性皮肤溃疡者易患坏死性筋膜炎。诱发因素为皮肤擦伤、烫伤、刺伤、动物或昆虫叮咬等。

苏立众提醒,该疾病病程发展较快,症状发展速度快且严重,并发症多,所以广大市民如出现咽痛等用药后不能缓解,一定要到医院及时就诊。

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