坏死性筋膜炎

白细胞 (WBC) 计数升高是一种非特异性的结果，可见于任何全身性感染或循环衰竭。白细胞计数降低可能是严重脓毒症的一种体征。如果存在播散性软组织感染，应怀疑坏死性筋膜炎的可能性。[5]Stevens DL, Bisno AL, Chambers HF, 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. 2014 Jul 15;59(2):e10-52.https://academic.oup.com/cid/article/59/2/e10/2895845

白细胞计数异常升高或降低，伴随或不伴随核左偏（多形核白细胞和/或带状细胞百分比升高）。

低钠血症是一种非特异性的结果，可见于任何系统性感染或循环衰竭。 如果存在弥漫性软组织感染，就应怀疑坏死性筋膜炎的可能性。[5]Stevens DL, Bisno AL, Chambers HF, 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. 2014 Jul 15;59(2):e10-52.https://academic.oup.com/cid/article/59/2/e10/2895845

钠水平可能下降。

可能见于任何系统性感染或循环衰竭的非特异性表现。 如果存在弥漫性软组织感染，就应怀疑坏死性筋膜炎的可能性。[5]Stevens DL, Bisno AL, Chambers HF, 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. 2014 Jul 15;59(2):e10-52.https://academic.oup.com/cid/article/59/2/e10/2895845

升高

C 反应蛋白升高是一种非特异性的结果，可能见于一些系统性感染。 如果存在弥漫性软组织感染，就应怀疑坏死性筋膜炎的可能性。[5]Stevens DL, Bisno AL, Chambers HF, 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. 2014 Jul 15;59(2):e10-52.https://academic.oup.com/cid/article/59/2/e10/2895845

升高

可能提示系统性感染或循环衰竭的非特异性表现。 如果存在弥漫性软组织感染，就应怀疑坏死性筋膜炎的可能性。[5]Stevens DL, Bisno AL, Chambers HF, 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. 2014 Jul 15;59(2):e10-52.https://academic.oup.com/cid/article/59/2/e10/2895845

升高

一种提示全身性感染的非特异性发现。入院时血清乳酸升水平高似乎与存在坏死性筋膜炎有关。[28]Murphy G, Markeson D, Choa R, et al. Raised serum lactate: a marker of necrotizing fasciitis? J Plast Reconstr Aesthet Surg. 2013 Dec;66(12):1712-6.

升高

通过外科清创中获得的组织样本进行细菌培养或者经血培养而得出明确的致病菌。[5]Stevens DL, Bisno AL, Chambers HF, 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. 2014 Jul 15;59(2):e10-52.https://academic.oup.com/cid/article/59/2/e10/2895845

阳性；可能提示多重细菌或单一细菌所致的感染

对临床感染组织进行染色可能提供致病微生物的早期征象。例如，小链革兰阳性球菌提示链球菌感染，而成簇的大球菌提示金黄色葡萄球菌。

存在差异

帮助确定患者的呼吸状态。

低氧血症、酸中毒

适当的情况下，理论上应对所有疑似坏死性筋膜的炎患者进行 X 线平片或 CT/MRI检查（如果可行）。 然而，当无法急诊行影像学检查，部分患者应行急诊手术，例如，当坏死性筋膜炎的风险高以及患者病情不稳时。[5]Stevens DL, Bisno AL, Chambers HF, 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. 2014 Jul 15;59(2):e10-52.https://academic.oup.com/cid/article/59/2/e10/2895845 影像学检查时如发现软组织气体，应强烈怀疑诊断的可能性，而影像学检查也可能反映受累组织的异常。[3]Hasham S, Matteucci P, Stanley PR, et al. Necrotising fasciitis. BMJ. 2005 Apr 9;330(7495):830-3. [Erratum in: BMJ. 2005 May 14;330(7500):1143.][4]Pasternack MS, Swartz MN. Cellulitis, necrotizing fasciitis, and subcutaneous tissue infections. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. Philadelphia, PA: Elsevier; 2015:1194-215.[7]Aronoff DM, Bloch KC. Assessing the relationship between the use of nonsteroidal antiinflammatory drugs and necrotizing fasciitis caused by group A streptococcus. Medicine (Baltimore). 2003 Jul;82(4):225-35.

沿着筋膜平面和/或软组织内气体蔓延的水肿

对于每个疑似有坏死性筋膜炎的病例，都应该进行外科会诊，以对感染性组织实施进一步的检验、探查和引流。[5]Stevens DL, Bisno AL, Chambers HF, 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. 2014 Jul 15;59(2):e10-52.https://academic.oup.com/cid/article/59/2/e10/2895845

坏死性软组织感染