It is reported that Xiao Ran underwent liposuction in Huayan Medical Beauty Hospital on May 2 this year. Shortly after the operation, she suffered from multiple pains all over her body, which continued to worsen. Only two days later, on the morning of May 4th, Xiao Ran experienced multiple organ failure and extensive skin ulceration. He was admitted to ICU of Hangzhou Greentown Hospital for emergency treatment, and then transferred to the Second Affiliated Hospital of Zhejiang Medical University for further treatment. After more than two months of treatment, the treatment failed and he died.
According to the nursing records of Huayan Medical Beauty Hospital, Xiao Ran first experienced abdominal pain after liposuction, and then spread to the chest and sacrococcygeal region. The doctor only gave indomethacin and ibuprofen to relieve pain, and did not give ECG monitoring and oxygen inhalation until the early morning of May 4, but at this time, the best treatment opportunity was missed.
From the diagnosis of the Second Affiliated Hospital of Zhejiang Medical University, it can be seen that the root cause of Xiao Ran's death was postoperative "necrotizing fasciitis", which led to septic shock and multiple organ failure. Why is the infection so serious after liposuction?
Necrotizing fasciitis is a rapidly developing and life-threatening bacterial infection, which can destroy epidermis, dermis, subcutaneous tissue, fascia and muscle, causing widespread infection and erosion of limbs. Hippocrates once described it as an ancient disease with high mortality.
According to incomplete statistics, the mortality rate of necrotizing fasciitis can be as high as 80%! Even if it is found early and treated early, its mortality rate can still reach about 30%. So once it happens, it will often be critical.
The cause of necrotizing fasciitis is mixed bacterial infection, and about 80% cases are induced by the destruction of skin integrity. It can happen in any invasive surgery, even minor surgery like liposuction. Therefore, other medical and aesthetic operations have the risk of necrotizing fasciitis in theory.
What bothers doctors is that patients with necrotizing fasciitis have basically no symptoms in the early stage, or only slight local signs and symptoms, which are not specific. Just as Xiao Ran first felt pain after the operation, he mistakenly made the doctor think that it was just ordinary postoperative wound pain.
Another early feature is skin erythema and edema, but it is very similar to common cellulitis and difficult to distinguish clinically. However, patients with necrotizing fasciitis will have progressive pain in a short time until the pain is unbearable, which is helpful to distinguish it from cellulitis.
Unfortunately, after Xiao Ran suffered from pain, the doctor immediately gave NSAIDs to relieve the pain. Drugs such as indomethacin and ibuprofen can cover up important manifestations such as fever and pain, leading to missed diagnosis. Therefore, in the treatment of postoperative pain, the etiology should be given priority, and blind analgesia may be counterproductive.
There is no clear diagnostic criteria for necrotizing fasciitis, but there are some laboratory indicators that can indicate the possibility of necrotizing fasciitis. However, LRINEC score can not be used as the gold standard, and the diagnosis should still be based on clinical manifestations.
Once diagnosed, surgery is the most important treatment. Striving for debridement within 24 hours requires severe amputation and thorough removal of necrotic tissue. Use empirical broad-spectrum antibiotics as soon as possible before the drug sensitivity results come out.
It can be seen that Xiao Ran was transferred to hospital only two days after the operation, with obvious tissue necrosis and shock, and has missed the golden rescue period of 24 hours. In the past two days, the nursing in the beauty hospital has made people stunned.
Looking at the postoperative treatment in Huayan Medical Beauty Hospital, firstly, Xiao Ran's postoperative pain was not taken seriously, and his shock was not corrected in time. Second, the transfer is delayed. But more importantly, why is there a serious infection in Xiao Ran?
In fact, the incidence of necrotizing fasciitis is only about 1/65438+ 10,000. At the moment when aseptic technology is popular, it is really wrong for such a serious infection to happen to young people without basic diseases.
There are two main reasons: first, the surgical instruments and related equipment in the ward are not completely disinfected; Second, the patient was infected before operation and was not suitable for surgery. No matter what the reason, the hospital is the main responsible party, and such a tragedy should have been avoided. The Hangzhou Municipal Health and Health Commission has informed that Huayan Medical Beauty Hospital will take full responsibility for this medical accident.
China's medical and beauty industry has reached the time of heavy-handed management. According to statistics, in 20 19, there were more than 60,000 medical and aesthetic institutions in China, but only 10000 qualified institutions. There are about 500,000 qualified employees, of which less than 10% are professional doctors. Professional plastic surgeons need a training period of about 8 years, but this is far from meeting the market demand.
Even qualified doctors have mostly switched from other majors to medical aesthetics. These doctors have not received systematic plastic surgery training, and the medical quality is worrying. The lack of medical beauty specialty in major medical colleges in China is also a major reason for the shortage of talents.
At present, plastic surgery still lacks clear industry standards and perfect perioperative management system, which leads to frequent medical accidents. It is estimated that about 654.38+10,000 people are disabled and die every year due to medical beauty. Such chaos is in urgent need of national unified standards to restrict it.
The medical and beauty market is mixed, and the choice needs to be more cautious. Conditional large hospitals are still the first choice. First, large hospitals have strict recruitment systems to ensure the professionalism of doctors. Secondly, the purchase channels of medical devices are transparent, which can avoid the harm of inferior drugs. In addition, general hospitals have more advantages in dealing with postoperative complications.
The dead have gone, and the alarm bell is ringing. I hope this tragedy won't happen again.
References: 1. MaxivonGlinski, etc. handhirkrochorplastchir . 202 1 jun； 53:3 12-3 19 . doi: 10. 1055/a- 138 1-8077。