medicina55巻10号

2018年09月発行

特集 クリティカル・ケアを極める—一歩進んだ総合内科医を目指して 内科クリティカル・ケア実践編─このパターンを押さえれば8割は対応可能

壊死性筋膜炎の早期診断

著者： 伊藤亮太¹

所属機関： ¹藤田保健衛生大学病院感染症科

ページ範囲：P.1610 - P.1613

Point
◎蜂窩織炎との鑑別は困難だが，「激痛」「急速進行性」「皮膚所見を越える部位の疼痛」などは早期診断の手掛かりとなる．
◎壊死性筋膜炎を疑ったら，早期に外科にコンサルトし，皮膚切開による確定診断を行うことが重要である．
◎治療の原則は，早期のデブリードマンと抗菌薬治療である．

参考文献

1）Stevens DL, et al：Practice guidelines for the diagnosis and management of skin and soft tissue infections；2014 update by the Infectious Diseases Society of America. Clin Infect Dis 59：e10-e52, 2014

2）Hasham S, et al：Necrotising fasciitis. BMJ 330：830-833, 2005

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4）Wong CH, et al：The LRINEC（Laboratory Risk Indicator for Necrotizing Fasciitis）score；A tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 32：1535-1541, 2004

5）Borschitz T, et al：Improvement of a clinical score for necrotizing fasciitis；‘Pain out of proportion’ and high CRP levels aid the diagnosis. PLoS One 10：e0132775, 2015

6）Hadeed GJ, et al：Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections；A single academic center experience. J Emerg Trauma Shock 9：22-27, 2016

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8）Wang C,et al：Hyperbaric oxygen for treating wounds；A systematic review of the literature. Arch Surg 138：272-280, 2003

9）Soh CR, et al：Hyperbaric oxygen therapy in necrotising soft tissue infections；A study of patients in the United States Nationwide Inpatient Sample. Intensive Care Med 38：1143-1151, 2012

10）Kaul R, et al：Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome─A comparative observational study. The Canadian Streptococcal Study Group. Clin Infect Dis 28：800-807, 1999

11）Darenberg J, et al：Intravenous immunoglobulin G therapy in streptococcal toxic shock syndrome；A European randomized, double-blind, placebo-controlled trial. Clin Infect Dis 37：333-340, 2003

12）Kadri SS, et al：Impact of intravenous immunoglobulin on survival in necrotizing fasciitis with vasopressor-dependent shock；A propensity score-matched analysis from 130 US hospitals. Clin Infect Dis 64：877-885, 2017

13）Madsen MB, et al：Immunoglobulin G for patients with necrotising soft tissue infection（INSTINCT）；A randomised, blinded, placebo-controlled trial. Intensive Care Med 43：1585-1593, 2017