“5.12”汶川大地震伤员气性坏疽的早期诊治
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摘要
目的探讨地震伤致气性坏疽的诊断以及救治方案。方法对"5.12"汶川地震收治的气性坏疽患者的临床表现,诊断及救治情况进行横断面分析。结果18例气性坏疽患者中行伤口扩创、敞开引流5例,截肢术13例,再次扩创8例,伤口延期缝合15例,植皮2例,18例患者创面均得到封闭,16例患者创面完全愈合,发生急性肾功能衰竭1例,骨筋膜室综合征4例。结论早期诊断、隔离,及时正确处理创面,积极治疗并发症以及全身支持治疗能提高地震伤致气性坏疽患者的临床疗效,保留肢体,降低死亡率。
ObjectiveTo explore the diagnosis and the therapeutic regimen of megaseism-originated clostridial myonecrosis. MethodsClinical manifestation,diagnosis and the rescuing and treating condition of the hospitalized patients with clostridial myonecrosis in"5.12"Wenchuan megaseism were cross-sectionally analysed. Results5 of 18 patients underwent enlarged debridement with open drainage,13 amputation,8 re-enlarged debridement,15 delayed suture of wound and 2 dermatoplasty. The raw surface of 18 patients was completely closed. Acute renal failure(ARF) occurred in 1 case and osteofascial compartment syndrome in 4. ConclusionEarly diagnosis and isolation,prompt and correct debridement,active treating complications and systemic supportive treatment can improve the clinical curative effect in the patients with clostridial myonecrosis originated from Wenchuan megaseism and reserve their limbs and make the mortality lower.
ObjectiveTo explore the diagnosis and the therapeutic regimen of megaseism-originated clostridial myonecrosis. MethodsClinical manifestation,diagnosis and the rescuing and treating condition of the hospitalized patients with clostridial myonecrosis in"5.12"Wenchuan megaseism were cross-sectionally analysed. Results5 of 18 patients underwent enlarged debridement with open drainage,13 amputation,8 re-enlarged debridement,15 delayed suture of wound and 2 dermatoplasty. The raw surface of 18 patients was completely closed. Acute renal failure(ARF) occurred in 1 case and osteofascial compartment syndrome in 4. ConclusionEarly diagnosis and isolation,prompt and correct debridement,active treating complications and systemic supportive treatment can improve the clinical curative effect in the patients with clostridial myonecrosis originated from Wenchuan megaseism and reserve their limbs and make the mortality lower.
引文
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[10]步秀兰.手术室气性坏疽手术的消毒隔离体会[J].当代护士,2008,4:69.[10]BU XL.Experience of degermation and isolation in operating room for operation of clostridial myonecrosis[J].Today Nurse,2008,4:69.Chinese
[2]秦文,李国勇,曾月东.创伤气性坏疽早期诊治体会[J].中国中医骨伤科杂志,2007,15(10):27-28.[2]QING W,LI GY,ZENG YD.Experience of early diagnosis and treatment of traumatic clostridial myonecrosis[J].Chinese Journal of Traditional Medical Traumatology and Orthopedics,2007,15(10):27-28.
[3]曾晓鹏,崔素珍.长骨骨折并发筋膜室综合征发病率的调查分析[J].中国现代医学杂志,2002,12(10):92-93.[3]ZENG XP,CUI SZ.Investigation and analysis of the incidence of compartment syndrome complicated by long bone fracture[J].China Journal of Modern Medicine,2002,12(10):92-93.Chi-nese
[4]苏健,李年丰.腹部创伤术后并发症的治疗体会(附22例分析)[J].中国现代医学杂志,2002,12(21):74,76.[4]SU J,LI NF.Experience of treating postoperative complications of injuries of abdomen(report of22cases)[J].China Journal of Modern Medicine,2002,12(21):74,76.Chinese
[5]王战朝.现代创伤与急救[M].北京:北京科学技术出版社,1997:105-107.[5]WANG ZC.Modern Trauma and Emergency Treatment[M].Bei-jing:Beijing Science and Technology Press,1997:105-107.Chinese
[6]NANCY F.Infectious myositis[J].Best Practice and Research Clinical Rheumatology,2006,20(6):1083-1097.
[7]王香莉.骨折合并气性坏疽感染的救治及护理[J].实用骨科杂志,2007,13(3):192-193.[7]WANG XL.Remedy and nursing for bone fracture complicated with clostridial myonecrosis infection[J].Journal of Practical Or-thopedics,2007,13(3):192-193.Chinese
[8]陈孝平.外科学[M].北京:人民卫生出版社,2002:223-224.[8]CHEN XP.Surgery[M].Beijing:People's Medical Publishing House,2002:223-224.Chinese
[9]董薪,宋烽,王艳.手术室特异性手术的感染控制与管理[J].中华医院感染学杂志,2007,17(11):1416-1417.[9]DONG X,SONG F,WANG Y.Infection control and management of specific operation in operating room[J].Chinese Journal of Nosocomiology,2007,17(11):1416-1417.Chinese
[10]步秀兰.手术室气性坏疽手术的消毒隔离体会[J].当代护士,2008,4:69.[10]BU XL.Experience of degermation and isolation in operating room for operation of clostridial myonecrosis[J].Today Nurse,2008,4:69.Chinese
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