汶川地震转院伤员中八例气性坏疽诊治分析

目的 分析汶川地震中8例气性坏疽患者的临床特点及诊治方法.方法 收集8例确诊为气性坏疽患者的临床资料,分析其临床特点.给予多次外科清创、敏感抗生素、高压氧及营养支持等治疗.结果 本组多数患者具有无肢体捻发音,而X线、CT或B超等发现组织间有气体的特点.全部患者渗出液涂片发现梭状芽孢杆菌,细菌培养主要为产气荚膜杆菌.大多数患者为混合感染.另外,伤肢有大量坏死组织与渗出液,患者红细胞下降,白细胞和血小板升高等特点.经过积极综合治疗,无一例患者死亡或因为气性坏疽而截肢.结论 地震所致开放性损伤多发,且多为混合感染,气性坏疽为其主要的特殊感染之一.彻底外科清创、敏感抗生素治疗是气性坏疽的主要治疗方法.正规高压氧及营养支持治疗是重要且行之有效的辅助治疗方法.

Diagnosis and treatment of gas gangrene in 8 transferred patients after China Wenchuan earthquake

Objective To analyze clinical manifestation,diagnosis and treatment of 8 patients with gas gangrene in Wenchuan earthquake.Methods Eight patients with gas gangrene in Wenchuan earthquake were selected for analysis on their clinical manifestations.We finally diagnosed gas gangrene based on patients'clinical manifestation and the cultured ciostridium in the focus of infection.All the patients were treated with antibiotics,repeated surgical debridement,hyperbaric oxygen and nutritional support.Results Most patients had no erepitation of the extremities but found gas in interstice of tissues identified by X-ray,B-ultrasound and CT scanning.Film preparation of efflusion of all patients showed clostridium and bacterial culture manifested mainly perfringens.Most patients were demonstrated to be with polyinfection.In addition,all patients were characterized by pitchy necrotic tissues,effusion,systemic decrease of red blood cells,increase of white blood cells and platelet.No death or amputation occurred under active combined therapy.Conciusions Earthquake induces mainly open trauma often combined with mixed infection,when gas gangrene is one of main special infections.The predominant combined therapies include utility of antibiotics and thorough surgical debridement,while hyperbaric oxygen and nutritional support are important and effective adjunctive therapies.