多学科联合治疗多发伤合并坏死性筋膜炎7例体会

目的探讨多学科联合治疗多发伤合并坏死性筋膜炎的治疗体会。方法对7例严重多发伤合并坏死性筋膜炎患者以创伤骨科为主体,多学科联合治疗的模式,快速评估伤情,在行损害控制性手术的同时早期使用广谱抗生素,涉及会阴部及肛周感染患者早期行结肠造瘘术,局部的彻底清创、引流,持续氧灌注下负压封闭引流(VSD),加强生命支持等积极诊疗措施。结果坏死性筋膜炎引起的重症感染被有效控制,创面经过拉拢缝合或二期植皮、皮瓣修复后,7例患者均治愈出院。结论对于严重多发伤合并坏死性筋膜炎患者,只有通过多学科综合治疗,发挥各自专业特长,遵循损害控制的原则,在积极治疗多发伤的同时,早期评估、早期使用有效的抗生素、早期造瘘、早期积极清创、充分引流,给予负压引流协助,能有效提高抢救成功率,降低并发症的发生率。     

分批次清创联合负压封闭引流治疗创伤弧菌感染致坏死性筋膜炎2例报告

【摘要】 给予 2021 年 10 月及 11 月广州市番禺区中心医院收治的 2 例创伤弧菌感染致坏死性筋膜炎患者在头孢哌酮钠舒巴坦钠+左氧氟沙星抗感染治疗的基础上, 局部创面行分批次清创联合负压封闭引流治疗, 分别于治疗 13 d 及 10 d 后, 创面坏死组织明显减少, 肉芽组织生长良好, 继而行减张缝合术封闭创面。     

多技术联合治愈胫前皮肤坏死伴坏死性筋膜炎1例报告

【摘要】 给予 2021 年 4 月西安市第九医院收治的 1 例胫前皮肤坏死伴坏死性筋膜炎患者在抗感染、营养支持等对症支持治疗的基础上, 局部创面于彻底清创后采用负压封闭引流、湿润烧伤膏换药及自体微粒皮种植治疗,治疗 51 d 后,创面完全愈合,患者出院;出院后随访 9 个月,愈后皮肤遗留浅表性瘢痕。     

湿润烧伤膏治疗急性坏死性筋膜炎的临床疗效观察

目的探讨单切口切开清创联合湿润烧伤膏（MEBO）药纱条引流治疗坏死性筋膜炎的临床疗效。方法将15例坏死性筋膜炎患者分为两组,分别采用单切口切开清创联合湿润烧伤膏药纱条引流（7例）及单切口切开清创联合凡士林纱条引流（8例）治疗,对比观察两组患者创面愈合情况。结果采用单切口切开清创联合湿润烧伤膏药纱条引流治疗的治疗组患者,平均住院时间为21d,明显短于采用单切口切开清创联合凡士林纱条引流治疗的患者（32d）。结论单切口切开清创联合湿润烧伤膏治疗坏死性筋膜炎,能够促进坏死组织尽早排除及创面愈合,疗效理想,值得临床推广应用。     

负压封闭引流联合局部持续微氧灌注治疗慢性难愈合创面疗效观察

目的 探讨负压封闭引流联合局部持续微氧灌注对慢性难愈合创面的治疗效果。方法 选取2018年1月至2020年1月东莞市大朗医院收治的50例慢性难愈合创面患者作为研究对象,根据不同治疗方法将其分为联合组25例与对照组25例,联合组患者行负压封闭引流联合局部持续微氧灌注治疗,对照组患者单纯行负压封闭引流治疗,对比两组患者换药次数、临床疗效、住院时间及患者满意度。结果 治疗2周后,联合组患者临床疗效明显优于对照组（Z=-3.140,P=0.002）,换药次数明显少于对照组（t=3.748,P=0.001）,住院时间明显短于对照组（t=10.690,P＜0.001）,患者满意度明显高于对照组（Z=-4.902,P＜0.001）。结论 负压封闭引流联合局部持续微氧灌注治疗慢性难愈合创面,有助于加快创面愈合,提高治疗效果,增加患者满意度,临床应用价值较高。     

会阴部坏死性筋膜炎临床诊治与误诊分析

目的探讨会阴部坏死性筋膜炎的发病机制、治疗要点及误诊原因,提高该病的临床诊疗水平。方法对8例误诊的会阴部坏死性筋膜炎患者的临床资料进行回顾性分析,总结其误诊原因,并在明确诊断后采用手术切开引流配合湿润烧伤膏药纱引流治疗,观察、分析该疗法的有效性,并归纳总结该病的诊疗方案。结果 8例患者中有6例因痔疮史被误诊为"肛周脓肿";1例因阴囊处皮肤被蚊虫叮咬后肿痛、体温升高被误诊为"皮肤软组织感染";1例因会阴部皮肤触痛且有硬结被误诊为"巴氏腺囊肿"。8例患者中有7例在切开引流术后经单纯应用湿润烧伤膏药纱引流治疗14~20 d后创面愈合;另外1例经湿润烧伤膏药纱引流治疗至肉芽组织完全覆盖创面后,给予手术植皮封闭创面,术后1个月创面完全愈合。所有患者随访0.5~6年,均未复发。结论临床医生应加强对会阴部坏死性筋膜炎的认识,选择合适的治疗方案,以减少误诊误治。     

右肩部及右上肢坏死性筋膜炎1例报告

我院收治1例右肩部、右上肢坏死性筋膜炎患者,行切开减压、彻底清创术,术后予以VSD负压吸引,同时应用大量有效抗生素以及营养支持治疗,疗效满意。     

急性坏死性筋膜炎2例治疗体会

<正>急性坏死性筋膜炎是较少见的严重外科感染性疾病,主要以广泛而迅速的皮下组织和筋膜坏死为特征的感染性疾病~([1])。急性坏死性筋膜炎可导致脂肪液化或皂化,起病急,发展迅速,伴有严重的全身中毒症状,病死率高~([2])。沈阳军区赤峰医院烧伤科收治2例急性坏死性筋膜炎患者,通过综合性治疗取得满意疗效。现报道如下。     

VSD技术联合新型伤口敷料序贯治疗泛耐药鲍曼不动杆菌坏死性筋膜炎1例

急性坏死性筋膜炎(acute necrotizing fasciitis,ANF)是一种严重的皮肤软组织感染性疾病,多见于会阴、肛周、腹部等组织疏松处,表现为皮肤、皮下组织、筋膜以及肌肉的广泛坏死,具有发展迅速、破坏力强等特点.常规使用清创引流的方法治疗急性坏死性筋膜炎往往效果不理想,尤其是合并耐药菌的创面,感染难以控...     

原位再生医疗技术治疗腹部术后切口感染的临床经验

目的 观察湿润烧伤膏（MEBO） 联合创疡贴在腹部术后切口感染伴坏死性筋膜炎治疗过程中加速创面愈合与控制感染的效果.方法 随机选择5 例妇科术后切口感染的患者,其中2 例患者伴有坏死性筋膜炎.所有患者在进行切口清创处理后,不再进行外科手术缝合,创面直接外涂湿润烧伤膏,然后用创疡贴覆盖治疗.结果 5 例患者创面全部愈合.结论 皮肤原位再生医疗技术（MEBT/ MEBO） 治疗腹部术后切口感染伴坏死性筋膜炎可有效地控制创面感染,促进创面愈合.     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.