汶川地震后送伤员并发相关感染的诊治体会
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摘要
目的探讨地震伤员伤口感染及并发气性坏疽的规律以及诊治方法。方法分析汶川地震后送伤员的受伤部位、程度、合并症、并发症、诊断、治疗方法及结果等。结果本组震后送伤员147例,其中骨折117例,占79.6%,包括多发性骨折49例,开放性骨折12例;合并多发性软组织挫裂伤31例,挤压伤9例。进行伤口分泌物涂片镜检、细菌培养和药物敏感试验41例,发现有细菌生长的感染共27例,其中软组织挫裂伤清创术后感染13例,开放性骨折术后感染7例,截肢术后感染3例,筋膜切开减压术后感染3例(气性坏疽1例),原发性气性坏疽1例。2例气性坏疽伤员均行截肢术以救治生命。术后所有伤口均痊愈。入院后截肢2例,无死亡者。结论地震伤具有战伤的多数特点,应按战伤分类处理。骨折伤员占地震伤的大多数,其中开放性骨折感染率高,现场急救应以清创为主,保持伤口开放引流,以利后期救治。
Objectives To explore the discipline,diagnoses and treatment of the complicated infections of the wounded persons during earthquake.Methods Analyse the injury sites,extent,associated diseases,complications,diagnoses,treatments and the clinical results of the wounded persons during Wenchuan earthquake.Results There were a total of 147 cases of wounded persons,including 117 cases of fractures(including multiple fractures in 49 cases and open fractures in 12 cases),accounting for 79.6% of the total,31 cases complicated with multiple soft tissue contusions or lacerations,and 9 cases of crush injuries.Microscopy of the wound swabs,germiculture and antibiotics sensitivity test were performed in 41 cases.And 27 cases were primary smear positive for bacteria,including 13 cases of infections after debridement of soft tissue contusions or lacerations,infections after debridement and immobilizations of open fractures in 7 cases,infections after amputations in 3 cases,infections after fasciotomies in 3 cases(gas gangrene in one case)and one case of primary gas gangrene.Amputations were performed in the two cases of gas gangrene to save their lives.All the wounded persons heal without death except two cases of amputations(gas gangrene) after admission.Conclusion Earthquake injuries feature with the most of the characteristics of battle field wounds,and should be managed and classified according to that of battle field wounds.Fractures accounte for the majority of earthquake injuries,in which open fractures are characterized with high incidence of infection.Debridement should be the major first-aids at the disaster sites and keeping open drainages of the wounds should facilitate the sequential treatment of the wounded persons.
Objectives To explore the discipline,diagnoses and treatment of the complicated infections of the wounded persons during earthquake.Methods Analyse the injury sites,extent,associated diseases,complications,diagnoses,treatments and the clinical results of the wounded persons during Wenchuan earthquake.Results There were a total of 147 cases of wounded persons,including 117 cases of fractures(including multiple fractures in 49 cases and open fractures in 12 cases),accounting for 79.6% of the total,31 cases complicated with multiple soft tissue contusions or lacerations,and 9 cases of crush injuries.Microscopy of the wound swabs,germiculture and antibiotics sensitivity test were performed in 41 cases.And 27 cases were primary smear positive for bacteria,including 13 cases of infections after debridement of soft tissue contusions or lacerations,infections after debridement and immobilizations of open fractures in 7 cases,infections after amputations in 3 cases,infections after fasciotomies in 3 cases(gas gangrene in one case)and one case of primary gas gangrene.Amputations were performed in the two cases of gas gangrene to save their lives.All the wounded persons heal without death except two cases of amputations(gas gangrene) after admission.Conclusion Earthquake injuries feature with the most of the characteristics of battle field wounds,and should be managed and classified according to that of battle field wounds.Fractures accounte for the majority of earthquake injuries,in which open fractures are characterized with high incidence of infection.Debridement should be the major first-aids at the disaster sites and keeping open drainages of the wounds should facilitate the sequential treatment of the wounded persons.
引文
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[3]王战朝.现代创伤与急救[M].北京:科学技术出版社,1997:105.
[4]刘晖,杨启菁.高压氧综合治疗气性坏疽60例[J].中华医院感染学杂志,2006,16(10):1127.
[5]De A,Varaiya A,Mathur M,et al.Bacteriological studiesof gas gangrene and related infections[J].Indian J MedMicrobiol,2003,21(3):202.
[6]孙本枢,施金镇.10例气性坏疽临床分析[J].福建医药杂志,1979,1(3):19.
[7]张渝,李初民,王放.地震灾难伤员检伤分类系统设计与实现[J].重庆医学,2008,37(21):2405.
[8]刘飙,孙英,魏壮,等.断肢再植术后并发气性坏疽3例[J].中华显微外科杂志,2004,27(1):42.
[9]吴阶平,裘法祖.黄家驷外科学[M].第5版.北京:人民卫生出版社,1994:7.
[10]王亦璁.创伤早期处理[M].北京:人民卫生出版社,1994:53.
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