Nekrotizan Fasiitte Erken Tanı ve Prognoz: 34 Hastanın Retrospektif İncelenmesi
Yükleniyor...
Tarih
2017
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışma, nekrotizan fasiitte (NF) erken tanı koyabilmek için yapılması gereken girişimleri belirlemek, erken yapılan ve gerekli olduğunda tekrarlanan cerrahi girişimin önemini göstermek ve laboratuar testleri ile prognoz hakkında fikir edinebilmek amacıyla planlandı. 2005-2010 yılları arasında başvuran ve NF tanısı konan 34 hasta çalışmaya alındı. Hastalar yaş, cinsiyet, etiyoloji, predispozan faktörler, laboratuvar bulguları, başvuru süresi, cerrahi debridman sayısı, enfeksiyonun yerleşim yeri, kültür sonuçları ve prognoz açısından geriye dönük olarak incelendi. En önemli etiyolojik faktörler cerrahi girişim ve yerel yumuşak doku enfeksiyonuydu. Predispozan faktörler arasında obezite ve diyabet dikkati çekiyordu. Hastaların hepsinin nekrotizan fasiit için laboratuvar risk göstergesi (LRINEC) skorları 7 ve üzerindeydi. Ortalama LRINEC skoru 9.1 (minimum 7, maksimum 13) olarak hesaplandı. Enfeksiyonun başlangıç yeri en sık karın, kasık ve perine bölgeleriydi. Sadece 11 hasta bulguları takiben ilk 48 saat içinde kliniğe başvurmuş, NF tanısı almış ve tedavisine başlanmıştı. Yapılan yara kültürlerinde 26 hastada üreme oldu. En çok üreyen mikroorganizmalar E. coli ve K. pneumoniae idi. Tedavi edilen 4 hasta kaybedildi. Bunlar geç başvuran (5- 10 gün), LRINEC skoru yüksek (ortalama 12), kronik hastalıkları olan (diyabet, obezite, kronik lenfositik lösemi) ve ileri yaşta (ortalama 74.7) hastalardı. LRINEC skoru yüksek, 65 yaşın üzerinde ve 5 günden daha geç başvuran hastaların prognozları kötüdür. NF düşünülen hastalarda erken tanı konulması için fizik muayene, laboratuvar testleri ve tanıya yönelik invazif girişimler zaman geçirilmeden uygulanmalıdır.
Present study was performed to determine the methods for early diagnosis of necrotizing fasciitis (NF), to indicate the importance of the early surgery and its repetition when necessary, and to predict the prognosis using laboratory tests. Study was performed with 34 patients who were diagnosed NF between 2005 and 2010. Prognosis were retrospectively inspected in terms of the age, gender, etiology, predisposing factors, laboratory findings, the application period, the number of surgical debridement, infection location and culture result of the patients . The most important etiological factors were found to be surgical intervention and local soft tissue infection. Among the predisposing factors of obesity and diabetes were found to be the most common. All patients had laboratory risk indicator for necrotizing fasciitis (LRINEC) score of 7 or above. The mean LRINEC score was found to be 9.1. Abdominal, groin and perineum were the common infection locations. Only 11 patients admitted to the hospital, diagnosed and received treatment for NF within the first 48 hours after the first symptoms. The wound cultures were positive in 26 patients. Most commonly grown microorganisms were E. coli and K. pneumoniae. Four patients who died during treatment were advanced age (mean 74.7), admitted late (5-10 days), had high LRINEC scores (mean, 12) and chronic diseases (diabetes, obesity, chronic lymphocytic leukemia). The patients who have high LRINEC score, over the age of 65 and admitted in 5 days or more after the first symptoms, were observed to have poor prognosis. Whenever a patient is suspected to have NF, physical examination, laboratory tests and invasive diagnostic procedures should be performed immediately in order to have an early diagnosis.
Present study was performed to determine the methods for early diagnosis of necrotizing fasciitis (NF), to indicate the importance of the early surgery and its repetition when necessary, and to predict the prognosis using laboratory tests. Study was performed with 34 patients who were diagnosed NF between 2005 and 2010. Prognosis were retrospectively inspected in terms of the age, gender, etiology, predisposing factors, laboratory findings, the application period, the number of surgical debridement, infection location and culture result of the patients . The most important etiological factors were found to be surgical intervention and local soft tissue infection. Among the predisposing factors of obesity and diabetes were found to be the most common. All patients had laboratory risk indicator for necrotizing fasciitis (LRINEC) score of 7 or above. The mean LRINEC score was found to be 9.1. Abdominal, groin and perineum were the common infection locations. Only 11 patients admitted to the hospital, diagnosed and received treatment for NF within the first 48 hours after the first symptoms. The wound cultures were positive in 26 patients. Most commonly grown microorganisms were E. coli and K. pneumoniae. Four patients who died during treatment were advanced age (mean 74.7), admitted late (5-10 days), had high LRINEC scores (mean, 12) and chronic diseases (diabetes, obesity, chronic lymphocytic leukemia). The patients who have high LRINEC score, over the age of 65 and admitted in 5 days or more after the first symptoms, were observed to have poor prognosis. Whenever a patient is suspected to have NF, physical examination, laboratory tests and invasive diagnostic procedures should be performed immediately in order to have an early diagnosis.
Açıklama
Anahtar Kelimeler
Genel ve Dahili Tıp, Nekrotizan Fasiit, Prognoz, Erken Tanı, Nekrotizing Fasciitis, Prognosis, Early Diagnosis
Kaynak
Selçuk Tıp Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
33
Sayı
2
Künye
Okur, M. İ., Yıldırım, A. M., Şen, T., İnce, B. (2017). Nekrotizan Fasiitte Erken Tanı ve Prognoz: 34 Hastanın Retrospektif İncelenmesi. Selçuk Tıp Dergisi, 33, 2, 22-25.
