概述

坏疽是指因血流量不足或严重细菌感染而导致的身体组织坏死。坏疽通常会影响四肢,包括脚趾、手指以及手臂和腿部,也可能出现于肌肉和内脏中。

如果您患有会损害血管并影响血流量的基础疾病,比如糖尿病或动脉硬化(动脉粥样硬化),您出现坏疽的几率更高。

坏疽治疗包括手术切除坏死组织、抗生素治疗和高压氧疗法。如果早期发现并及时治疗坏疽,康复的预后较好。

症状

影响您皮肤的坏疽体征和症状包括:

  • 皮肤变色 — 根据坏疽类型,变色程度从苍白色、蓝色、紫色、黑色、青铜色到红色不等
  • 皮肤肿胀或皮肤上形成充满液体的水疱
  • 健康皮肤和受损皮肤之间有明显界限
  • 突然剧烈疼痛,紧接着是麻木感
  • 疮处流出难闻的排出物
  • 皮肤变薄发亮或皮肤无毛
  • 皮肤摸起来凉爽或冰凉

如果您患有气性坏疽或内坏疽等影响皮下组织类型的坏疽,您可能会发现:

  • 受影响皮肤肿胀且非常疼痛
  • 持续低烧,一般会感觉不舒服

如果坏疽性组织内的细菌感染扩散到全身,则会导致脓毒性休克这个疾病。脓毒性休克的体征和症状包括:

  • 低血压
  • 发热,但体温可能低于 37 C (98.6 F)
  • 心率加快
  • 头重脚轻
  • 气短
  • 意识模糊

何时就诊

坏疽是一种严重疾病,需要立即治疗。如果您身体任何部位出现持续的、无法解释的疼痛,并伴有以下一个或多个体征和症状,请立即致电您的医生:

  • 持续发热
  • 皮肤变化 — 包括污色、发热、肿胀、水疱或病变,且症状不会消失
  • 疮处流出难闻的排出物
  • 近期手术或创伤部位突然疼痛
  • 皮肤苍白、坚硬、寒冷和麻木

病因

以下一个或多个原因可能导致坏疽:

  • 供血不足。您的血液提供氧和营养物来供养细胞和抗体等免疫系统组织成分,从而防止感染。没有适量供血,细胞无法存活,您的组织会衰败。
  • 感染。如果细菌长期无节制繁殖,就会发生感染,导致组织死亡,形成坏疽。
  • 创伤。枪伤或撞车形成的压伤等创伤会使细菌深度入侵身体组织。这类组织感染会导致坏疽。

坏疽类型

  • 干性坏疽。干性坏疽的特点是皮肤干燥、萎缩,皮肤颜色从棕色到紫蓝色到黑色不等。干性坏疽可能缓慢形成。患有动脉粥样硬化等动脉血管疾病的人或患有糖尿病的人最常出现坏疽。
  • 湿性坏疽。如果受影响的组织感染细菌,这种坏疽是指“湿性”坏疽。湿性坏疽常见的特征是肿胀、水疱、表面湿润。

    严重烧伤、冻伤或损伤后可能出现湿性坏疽。患有糖尿病的人如果无意中损伤脚趾或足部,通常会出现湿性坏疽。湿性坏疽扩散很快且致命,需要立刻治疗。

  • 气性坏疽。气性坏疽通常影响深层的肌肉组织。如果您患有气性坏疽,您的皮肤表面一开始看上去很正常。

    随着情况发展,您的皮肤可能变暗淡,进而变成灰色或紫红色。可明显看到您的皮肤表面起泡,您如果轻按受影响的皮肤,可能会发出噼啪声,那是组织里面的气体造成的。

    气性坏疽最常见的病因是产气荚膜梭状芽胞杆菌感染,而导致供血枯竭的损伤或手术创伤会出现这种感染。细菌感染产生毒素,毒素释放气体(“气性”坏疽也因此得名),而后导致组织死亡。气性坏疽和湿性坏疽一样是致命的。

  • 内坏疽。影响您的肠道、胆囊或阑尾等一个或多个器官的坏疽称为内坏疽。如果通向内部器官的血流受阻,例如您腹部肌肉较弱部位的肠凸起(疝气)并变得扭曲,就会出现这类坏疽。

    内坏疽可能造成发热和严重疼痛。内坏疽不加治疗会致命。

  • 福尼尔坏疽。福尼尔坏疽影响生殖器官。通常男性比较受影响,但女性也会出现这类坏疽。福尼尔坏疽的常见原因是生殖器部位感染或尿路感染,会造成生殖器疼痛、压痛、泛红和肿胀。
  • 进行性细菌协同性坏疽(梅勒尼坏疽)。这种罕见的坏疽类型通常在手术后出现,伴有疼痛性皮损,皮损会在术后一至两周出现。

Types of gangrene

  • Dry gangrene. This type of gangrene involves dry and shriveled skin that looks brown to purplish blue or black. Dry gangrene may develop slowly. It occurs most commonly in people who have diabetes or blood vessel disease, such as atherosclerosis.
  • Wet gangrene. Gangrene is referred to as wet if there's a bacterial infection in the affected tissue. Swelling, blistering and a wet appearance are common features of wet gangrene.

    Wet gangrene may develop after a severe burn, frostbite or injury. It often occurs in people with diabetes who unknowingly injure a toe or foot. Wet gangrene needs to be treated immediately because it spreads quickly and can be deadly.

  • Gas gangrene. Gas gangrene typically affects deep muscle tissue. If you have gas gangrene, the surface of your skin may look normal at first.

    As the condition worsens, your skin may become pale and then turn gray or purplish red. The skin may look bubbly and may make a crackling sound when you press on it because of the gas within the tissue.

    Gas gangrene is most commonly caused by infection with a bacterium called Clostridium perfringens. Bacteria gather in an injury or surgical wound that has no blood supply. The bacterial infection produces toxins that release gas and cause tissue death. Like wet gangrene, gas gangrene is a life-threatening condition.

  • Internal gangrene. Gangrene that affects one or more of your organs, such as your intestines, gallbladder or appendix, is called internal gangrene. This type of gangrene occurs when blood flow to an internal organ is blocked — for example, when your intestines bulge through a weakened area of muscle in your stomach area (hernia) and become twisted.

    Left untreated, internal gangrene can be deadly.

  • Fournier's gangrene. Fournier's gangrene involves the genital organs. Men are more often affected, but women also can develop this type of gangrene. An infection in the genital area or urinary tract causes this type of gangrene.
  • Meleney's gangrene. This rare type of gangrene — also called progressive bacterial synergistic gangrene — is usually a complication of surgery. People with Meleney's gangrene develop painful skin lesions one to two weeks after their operations.

风险因素

有几个因素会增加您患坏疽的风险。这些包括:

  • 糖尿病。如果您有糖尿病,您体内的胰岛素(这个激素帮助细胞吸收血糖)就会不足或您的身体抵制胰岛素的作用。高血糖水平最终损伤血管,减少或打乱部分身体的血流。
  • 血管疾病。变硬变窄的动脉(动脉粥样硬化)和血凝块也会阻塞某个身体部位的血流。
  • 重度损伤或外科手术。对您的皮肤和基本组织造成损伤或冻伤等创伤的任何手术都会增加您患坏疽的风险,尤其是如果您的基础病会影响受损部位的血流。
  • 抽烟。抽烟的人患坏疽的风险更高。
  • 肥胖症。肥胖症通常伴随糖尿病和血管疾病,但超重形成的压力本身会挤压动脉,导致血流减少并增加您受感染和创伤愈合不良的风险。
  • 免疫抑制。如果您感染艾滋病毒或您正接受化疗或放射疗法,您身体的抗感染能力会受损。
  • 注射类用药或毒品。已证实,注射类特定药物和违禁药物会使人感染致坏疽细菌,但这很少见。

并发症

坏疽会致使瘢痕形成或需要实施重建外科手术。有时,如果组织死亡量过多,则可能需要切除脚等部分身体部位(截肢)。

细菌感染性坏疽会很快扩散到其他器官,如不加治疗可能致命。

预防

以下几条建议可以帮助您降低患坏疽的风险:

  • 控制好糖尿病。如果您患有糖尿病,请确保每天检查您的手脚是否出现伤口、疮疡和感染的体征(如发红、肿胀或排液)。每年至少看一次医生,对您的手脚做检查,并试着维持您的血糖水平。
  • 减轻体重。超重不但会增加患上糖尿病的机会,还会对您的动脉造成负担,限制血流,并增加您感染的风险,使伤口愈合减缓。
  • 不要吸烟。长期吸烟会损伤您的血管。
  • 帮助预防感染。用温和的肥皂和水清洗开放性伤口,并保持伤口清洁干燥直至其愈合。
  • 温度降低时多加注意。冻伤的皮肤可能引起坏疽,因为冻伤会减缓受影响区域的血液循环。如果在长期暴露在低温环境中之后,您注意到您身上任意部位的皮肤变白、变硬、变冷且变得麻木,请联系您的医生。

Jan. 13, 2022
  1. Usatine RP, et al., eds. Dry gangrene. In: The Color Atlas of Family Medicine. 2nd ed. New York, N.Y.: McGraw-Hill; 2013. http://accessmedicine.mhmedical.com. Accessed March 13, 2017.
  2. Stevens D, et al. Clostridial myonecrosis. http://www.uptodate.com/home. Accessed March 13, 2017.
  3. Bryant A, et al., eds. Gas gangrene and other clostridial infections. In: Harrison's Principles of Internal Medicine. 19th ed. New York, N.Y.: McGraw-Hill; 2014. http://accessmedicine.mhmedical.com/content.aspx?bookid=1130§ionid=79735535. Accessed March 13, 2017.
  4. Conly J., eds. Soft tissue infections. In: Principles of Critical Care. 4th ed. New York, N.Y.: McGraw-Hill; 2014. http://accessmedicine.mhmedical.com. Accessed March 13, 2017.
  5. Tubbs RJ, et al., eds. Extremity conditions. In: The Atlas of Emergency Medicine. 4th ed. New York, N.Y.: McGraw-Hill; 2016. http://accessmedicine.mhmedical.com. Accessed March 13, 2017.
  6. Lipworth AD, et al., eds. Necrotizing soft tissue infections: Necrotizing fasciitis, gangrenous cellulitis, and myonecrosis. In: Fitzpatrick's Dermatology in General Medicine. 8th ed. New York, N.Y.: McGraw-Hill; 2016. http://accessmedicine.mhmedical.com. Accessed March 13, 2017.
  7. Schwarts BS, et al., eds. Bacterial and chlamydial infections. In: Current Medical Diagnosis & Treatment 2017. 56th ed. New York, N.Y.: McGraw-Hill; 2017. http://accessmedicine.mhmedical.com. Accessed March 13, 2017.
  8. Ogle JW et al., eds. Infections: Bacterial and spirochetal. In: Current Diagnosis & Treatment Pediatrics. 23rd ed. New York, NY: McGraw-Hill; 2016. http://accessmedicine.mhmedical.com. Accessed March 13, 2017.
  9. Mechem CC, et al. Hyperbaric oxygen therapy. http://www.uptodate.com/home. Accessed March 27, 2017.

相关

Associated Procedures