資料來源:N ENGL J MED 388;24 NEJM.ORG June 15,2023



一名 32 歲男性因胸部傷口擴大已有 1 個月的歷史而被送往急診室。 他報告了 3 年每天使用透過頸部和手臂靜脈注射摻有甲苯噻嗪(賽拉嗪,Xylazine)的芬太尼的歷史。 體檢顯示上胸部有壞死傷口,鎖骨暴露(圖 A)。 胸部電腦斷層掃描顯示鎖骨和柄骨髓炎,以及軟組織潰瘍和炎症。 組織培養培養了銅綠假單胞菌和腸球菌。 診斷為甲苯噻嗪相關皮膚損傷併發軟組織感染和骨髓炎。 進行了胸壁清創術(圖B)和顯微外科皮瓣重建(圖C)。 入院時開始靜脈抗菌治療,術後持續 6 週。 開始丁丙諾啡治療是為了治療患者的阿片類藥物使用障礙。 Xylazine(也稱為“tranq”,鎮定劑)是一種 α2 腎上腺素受體激動劑,僅被批准用於獸醫用途。 在美國,它是一種越來越流行的芬太尼添加劑。 賽拉嗪與皮膚損傷有關——通常發生在腿部(圖 D,不同的患者)——無論注射部位如何,都可能發生。 6個月的追蹤中,患者的傷口癒合良好,並且他一直在參加門診戒毒計畫。



Xylazine-Associated Skin Injury

N ENGL J MED 388;24 NEJM.ORG June 15,2023

A 32-year-old man presented to the emergency department with a 1-month history of enlarging chest wounds. He reported a 3-year history of daily use of fentanyl adulterated with xylazine by injection into his neck and arm veins. Physical examination showed necrotic wounds on the upper chest with exposure of the underlying clavicles (Panel A). Computed tomography of the chest showed osteomyelitis of the clavicles and manubrium, in addition to softtissue ulceration and inflammation. A tissue culture grew Pseudomonas aeruginosa and enterococcus species. A diagnosis of xylazine-associated skin injury complicated by soft-tissue infection and osteomyelitis was made. Chest-wall débridement (Panel B) and microsurgical flap reconstruction (Panel C) were performed. Intravenous antimicrobial therapy was initiated on admission and continued for 6 weeks postoperatively. Buprenorphine therapy was initiated to treat the patient’s opioiduse disorder. Xylazine (also known as “tranq”) is an α2 -adrenergic receptor agonist that has been approved only for veterinary use. It is an increasingly prevalent additive to fentanyl in the United States. Xylazine is associated with skin injury — commonly on the legs (Panel D, different patient) — that can occur regardless of the site of injection. At the 6-month follow-up visit, the patient’s wounds had healed well, and he had been participating in an outpatient addiction program.

DOI: 10.1056/NEJMicm2303601

Copyright © 2023 Massachusetts Medical Society.

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