小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 疼痛
- 水肿或肿胀
- 皮肤色素减退
- 捻发音（气性坏疽
其他诊断因素
- 足动脉搏动和踝臂指数（缺血性坏疽）减少
- 轻度发热和发冷（感染性坏疽
危险因素
- 糖尿病
- 动脉粥样硬化（缺血性坏疽
- 吸烟（缺血性坏疽
- 肾脏疾病
- 药物或者酒精滥用
- 恶性肿瘤
- 外伤或腹部手术（感染性坏疽
- 伤口污染（感染性坏疽
- 免疫抑制（感染性坏疽
- 营养不良（感染性坏疽
- 易凝状态（缺血性坏疽
- 长期应用止血带（缺血性坏疽
- 社区获得性甲氧西林耐药金黄色葡萄球菌
诊断性检查
首要检查
- 全血细胞计数（FBC
- 生化全项
- 血清乳酸脱氢酶
- 凝血检查组合
- 血液培养
- 血清 CRP
- X 线平片检查
- 患病部位 CT
- 患病部位 MRI
- 多普勒超声检查
需考虑的检查
- 手术探查和皮肤活检
- CT 血管造影术
- 磁共振血管造影术 (MRA)
- 胸部和腹部 CT
- 抗核抗体（ANA）、狼疮抗凝物、抗心磷脂和抗 β2-糖蛋白 1 抗体
- 血清冷凝集素
- 血清冷纤维蛋白原
- 血浆冷球蛋白
治疗流程
坏死性筋膜炎等待微生物培养及药敏结果的确认
确定 I 型坏死性筋膜炎（多菌性感染
确认的 II 型坏死性筋膜炎（单一微生物感染
气性坏疽
缺血性坏疽
撰稿人
作者
Jason Jacob, MD
Attending Physician
Assistant Director
Department of Medicine
Hartford Hospital
Hartford
CT
利益声明
JJ declares that he has no competing interests.
Robert J. Gionfriddo, DO
Assistant Director
Department of Medicine
Hartford Hospital
Hartford
CT
利益声明
RJG declares that he has no competing interests.
鸣谢
Dr Jason Jacob and Dr Robert J. Gionfriddo would like to gratefully acknowledge Dr William Tennant, Dr Badr Aljabri, Dr Mohammed Al-Omran, Dr Jose Contreras-Ruiz, and Dr Iris Galvan-Martinez, the previous contributors to this topic.
利益声明
WT, BA, MA, JC, and IG declare that they have no competing interests.
同行评议者
Meryl Davis, MD
Consultant Vascular Surgeon
Royal Free Hampstead
London
UK
利益声明
MD declares that she has no competing interests.
Charles Fox, MD
Vascular Surgeon
Department of Surgery
Walter Reed Army Medical Center
Washington
DC
利益声明
CF declares that he has no competing interests.
鉴别诊断
- 葡萄球菌性烫伤样皮肤病变
- 丹毒
- 蜂窝织炎
更多 鉴别诊断指南
- 手术部位感染：预防和治疗
- 慢性肢体威胁性缺血的管理
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