摘要
目的探讨医源性库欣综合征患者感染性创面的特点及综合治疗方法。方法采用回顾性观察性研究方法。2012年5月—2021年12月,收集广西医科大学第一附属医院烧伤整形外科出院的19例医源性库欣综合征患者资料,患者中男8例、女11例,年龄28~71(56±11)岁;其感染性创面中有12例为急性创面,7例为慢性创面,病变位于四肢、肛周及骶尾部,原始感染范围9 cm×5 cm~85 cm×45 cm。入院后行多学科协助诊疗,对创面行清创+负压封闭引流,再根据创面大小、感染严重程度、缝合张力、骨及肌腱等外露情况,选择直接缝合或自体皮和/或人工真皮和/或自体组织瓣移植等不同方法进行创面修复。统计患者入院后24 h内8:00、16:00和24:00的皮质醇及促肾上腺皮质激素(ACTH)水平以及患者入院后的手术次数、创面修复方式、创面愈合情况、供皮/供瓣区愈合情况。随访,观察创面是否复发感染。结果16例患者入院后24 h内8:00、16:00和24:00的皮质醇水平依次为(130±54)、(80±16)、(109±39)nmol/L,ACTH水平依次为(7.2±2.8)、(4.1±1.8)、(6.0±3.0)pg/mL;另外3例患者无此统计结果。入院后,患者手术次数为(3.4±0.9)次。患者创面修复方式:行直接缝合者4例;行自体皮和/或人工真皮移植者9例,其中2例Ⅰ期行人工真皮移植、Ⅱ期行自体皮移植;行带蒂逆行岛状皮瓣+自体皮移植者6例。患者创面愈合情况:行直接缝合的创面均愈合良好;行自体皮和/或人工真皮移植的6例患者创面愈合良好,3例经二次植皮后创面愈合良好;行皮瓣移植的4例患者创面愈合良好,2例患者小腿后侧动脉穿支皮瓣远端回流障碍,经Ⅱ期清创植皮后愈合良好。患者供皮/供瓣区愈合情况:行头部刃厚皮回植的4例患者大腿中厚皮供皮区均愈合良好;3例患者中厚皮供皮区未行刃厚皮回植,其中2例患者供皮区愈合不良,术后2周经二次植皮修复后愈合良好;2例患�
Objective To investigate the characteristics and comprehensive treatment of infected wounds in patients with iatrogenic Cushing's syndrome.Methods A retrospective observational study was conducted.From May 2012 to December 2021,the data of 19 patients with iatrogenic Cushing's syndrome discharged from the Department of Burns and Plastic Surgery of the First Affiliated Hospital of Guangxi Medical University were collected,including 8 males and 11 females,aged 28-71(56±11)years,with 12 cases of infected acute wounds and 7 cases of infected chronic wounds.The lesions were located in the limbs,perianal,and sacrococcygeal regions,with original infection ranging from 9 cm×5 cm to 85 cm×45 cm.After admission,the patients were performed with multidisciplinary assisted diagnosis and treatment,and the wounds were treated with debridement and vacuum sealing drainage,according to the size,severity of infection,suture tension,and bone and tendon tissue exposure of wounds,direct suture or autologous skin and/or artificial dermis and/or autologous tissue flap transplantation was selected for wound repair.The levels of cortisol and adrenocorticotropic hormone(ACTH)of patients at 8:00,16:00,and 24:00 within 24 h after admission were counted.After admission,the number of operations,wound repair methods,and wound and skin/flap donor site healing of patients were recorded.During follow-up,the wounds were observed for recurrent infection.Results The cortisol levels of 16 patients at 8:00,16:00,and 24:00 within 24 h after admission were(130±54),(80±16),and(109±39)nmol/L,respectively,and ACTH levels were(7.2±2.8),(4.1±1.8),and(6.0±3.0)pg/mL,respectively;and the other 3 patients had no such statistical results.After admission,the number of surgical operation for patients was 3.4±0.9.The following methods were used for wound repair,including direct suturing in 4 cases and autologous skin and/or artificial dermis grafting in 9 cases,of which 2 cases underwent stageⅡautologous skin grafting after artificial dermis grafting in s
作者
李顺堂
林源
欧斌贤
刘达恩
李德绘
农庆文
吴亚军
邱淑玫
黄振兴
Shuntang Li;Yuan Lin;Binxian Ou;Da'en Liu;Dehui Li;Qingwen Nong;Yajun Wu;Shumei Qiu;Zhenxing Huang(Department of Burns and Plastic Surgery,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Endocrinology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)
出处
《中华烧伤与创面修复杂志》
CAS
CSCD
北大核心
2022年第6期512-519,共8页
Chinese Journal of Burns And Wounds
基金
广西再生医学重点实验室开放课题(桂再重开1704)。
关键词
自身免疫疾病
感染
伤口愈合
促肾上腺皮质激素
皮肤移植
外科皮瓣
库欣综合征
Autoimmune diseases
Infection
Wound healing
Adrenocorticotropic hormone
Skin transplantation
Surgical flaps
Cushing's syndrome
