Zgorzel gazowa to proces zapalny, w przebiegu którego dochodzi do martwicy tkanki mięśniowej i łącznej z wytworzeniem gazu. Następstwem zgorzeli gazowej może być wstrząs toksyczny, a w konsekwencji zgon pacjenta. Jakie są objawy zgorzeli gazowej i co ją powoduje?
Do wytworzenia zgorzeli gazowej dochodzi na skutek zakażenia rany. Głównym czynnikiem etiologicznym są bakterie beztlenowe z rodzaju Clostridium perfringens.
Ryzyko zgorzeli gazowej występuje w przypadku ran zanieczyszczonych i pourazowych (zwłaszcza ran miażdżonych i tłuczonych) oraz ran kąsanych. Szczególnie podatne na zakażenie są tkanki niedokrwione. Z tego względu ryzyko wystąpienia zgorzeli gazowej jest wysokie u osób chorujących na cukrzycę oraz chorobę tętnic obwodowych.
Zgorzel gazowa może również stanowić powikłanie operacji chirurgicznych w obrębie jamy brzusznej (przypadki jatrogenne). Dodatkowym czynnikiem ryzyka jest upośledzenie odporności spowodowane np. chorobą nowotworową lub zakażeniem wirusem HIV.
Obraz kliniczny zgorzeli gazowej
Cechą charakterystyczną zgorzeli gazowej jest brunatny wysięk o mdłym, słodkim zapachu, któremu towarzyszy stan zapalny i twardy obrzęk. Ze względu na gromadzenie się gazu wytwarzanego przez bakterie w badaniu palpacyjnym można wyczuć trzeszczenie pęcherzyków. Otaczająca ranę skóra jest wyraźnie ochłodzona i blada. Pacjent odczuwa silne dolegliwości bólowe.
W przebiegu procesu chorobowego dochodzi do zakrzepów w drobnych naczyniach krwionośnych, czego konsekwencją jest pojawienie się martwicy w obrębie tkanki podskórnej i mięśniowej.
Zmianom chorobowym w obrębie rany mogą towarzyszyć objawy ogólne, takie jak obniżone ciśnienie tętnicze, podwyższona temperatura, wymioty, bóle brzucha, zasinienie skóry. Objawy te występują zwykle po kilku godzinach od pojawienia się objawów miejscowych.
W wyniku przedostania się toksyn produkowanych przez bakterie do krwiobiegu może dojść do wstrząsu, który stanowi bezpośrednie zagrożenie życia pacjenta.
Od momentu wystąpienia objawów zmiany chorobowe postępują w szybkim tempie. Zgon pacjenta może nastąpić już w ciągu 12 godzin.
Leczenie zgorzeli gazowej
Podstawowym elementem terapii jest chirurgiczne opracowanie rany wraz z usunięciem tkanek nekrotycznych. W przypadku zaawansowanych i rozległych zmian konieczna może być amputacja kończyny objętej procesem chorobowym lub jej części. Niezbędna jest również antybiotykoterapia. Jako metodę wspomagającą w części przypadków stosuje się terapię tlenem hiperbarycznym.
Źródło:
Heczko P., Pietrzyk A., Wróblewska M., Mikrobiologia lekarska, Warszawa 2016.
Szmidt J, Kużdzał J. i in., Podstawy chirurgii, Kraków 2009.
Przeczytaj także: Bakteria jak w sieci pająka: naukowcy odkryli nowe mechanizmy immunologiczne
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