Author/Editor		Rakovec, Slavko; Gaberšek, Ivo
Title		Kirurško zdravljenje nekrotizirajočega fasciitisa
Translated title		Surgical treatment of necrotising fasciitis
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 66, št. Suppl 1
Publication year		1997
Volume		str. I-3-7
Language		slo
Abstract		Background. In the last decade a steady increse of the number of patients with necrotising fasciitis (NF) was noticed. Analysis of the cases in the last years is therefore important to find out the most adequate diagnostic and therapeutic treatment. Patients and methods. Our cases of NF, treated since the year 1982, are demonstrated. There were 33 patients with two types od NF: type 1, where mixed bacterial flora was isolated and type 2 with beta haemolytic strepococci of the group A as the predominant pathogens. All the patients were operated on, most of them many times. The treatment was longlasting, the average length of hospitalisation was 47 days. There were four death (12%). Conclusions. Although the diagnosis of NF is usualy dificult, it is extremely important to find it out as soon as possible. NF should be suspected especially in patients with decreased defences. The most important symptom is an acute pain in the diseased region. There are no other symptoms and signs present in the first period. Some hours later often a general reaction may be observed: high fever and low systolic pressure (below 90 mm Hg). Later visible skin changes following thrombosis of the superficial vessels become obvious. Intensive treatment has to be started as soon as the general affection is observed and surgical treatment, which must be extensive enough, at least when skin changes are noticed. Only the appropriate and early treatment can succeed in shortening of the time of hospital stay, in decreasing the lasting damage of the patients health and also in lowering the mortality.
Summary		Izhodišča. V zadnjem desetletju opažamo postopno večanje števila bolnikov z nekrotizirajočim fasciitisom (NF). To nas je spodbudilo k obravnavi dosedanjih primerov in oblikovanju najbolj ustreznega diagnostičnega in terapevtskega pristopa. Bolniki in metode. V članku so prikazani naši primeri NF od leta 1982 dalje. Zdravili smo 33 bolnikov, ki smo jih razvrstili v NF oblike 1, pri kateri je bila osamljena flora, in v NF oblike 2, pri kateri so bili osamljeni beta hemolitični streptokoki skupine A v čisti ali mešani kulturi. Vsi bolniki so bili operirani, večina večkrat. Zdravljenje je bilo dolgotrajno, povprečna doba hospitalizacije je bila 47 dni. Umrli so štirje bolniki (12%). Zaključki. Diagnoza NF je večinoma težavna, vendar moramo narediti vse, da jo čimprej ugotovimo. Na to bolezen moramo misliti zlasti pri bolnikih z manjšo biološko odpornostjo. Najvažnejši simptom bolezni je ostra, hitro razvijajoča se bolečina v bolnem področju. V začetnem obdobju ni najti nobenih drugih simptomov ali znakov. Nekaj ur kasneje se pogosto pojavi splošna prizadetost zlasti visoka telesna temperatura ter znižanje sistoličnega tlaka (pod 90 mm Hg). Šele nato se pojavijo vidne spremembe na koži kot posledica tromboze žilja površinskih tkiv. Z intenzivnim zdravljenjem moramo začeti, ko se začenja pojavljati splošna prizadetost, s kirurškim, ki mora biti dovolj obsežno, pa vsaj takrat, ko se pojavijo spremembe na koži. Samo pravilno in pravočasno ukrepanje lahko prispeva k zmanjšanju dolgotrajnosti zdravljenja, k manjšem obsegu trajnih posledic in tudi k manjši smrtnosti.
Descriptors		FASCIITIS, NECROTIZING BACTERIA ANTIBIOTICS HOSPITALIZATION LENGTH OF STAY TREATMENT OUTCOME