地震开放性损伤伴感染转运伤员的临床特点及疗效分析

目的 分析汶川地震开放性损伤伴感染转运伤员的临床特点,总结其治疗经验.方法对我科2008年5月13日-2008年6月10日收治的54例汶川地震开放性损伤伴感染转运伤员进行分析、总结.治疗方法包括:在全身支持治疗的基础上对创口行反复彻底清创,在细菌培养和药敏试验基础上抗感染治疗,并行高压氧辅助治疗,对开放性骨折患者行外固定支架固定.结果所有地震开放伤均有感染,且多为混合感染,以G+球菌和G-杆菌为主,大部分患者合并厌氧菌感染.54例患者中无一例死亡,1例院外截肢患者因残端感染严重而行多次行残端清创、修整.除2例患者外,其余患者伤口均愈合.骨折患者骨折复位好,外固定牢靠,目前正处于康复中.结论在积极抗感染的基础上反复、彻底地清创和正确及时地闭合创口是降低死亡率和致残率的关键,根据感染特点予以恰当的辅助治疗可明显提高疗效.

Clinical features of and therapeutic analysis on 54 transferred patients with open injuries combined with infection in Chinese Wenchuan earthquake

Objective To analyze the clinical features of patients with open injuries combined with infections in Chinese Wenchuan earthquake and summarize the therapeutic experience. Methods An analysis was done on 54 patients with open injuries combined with infection transferred to our depart-ment from May 13, 2008 to June 10, 2008. Thorough debridement was performed based on general sup-porting management and anti-bacterial thempies done on the basis of results of bacteria culture and sus-ceptibility test. In the meantime, other managements including high-pressure oxygen therapy and external fixation were done for open fractures. Results Infection could be found in all open injuries, primarily combined infections with G+ coccus and G- bacillus or anaerobic. Moreover, most of the patients were infected by anaerobia. Of all, 1 patient with amputation received multiple debridement and repair because of severe infection of the amputation site and no death occurred. All patients recovered uneventfully, with sound wound healing, except for 2 patients. External fixation was stable and in good position. Conclu-sions The repeated and thorough debridement and the timely closure of wounds on the basis of energeti-cally anti-infection measures are key to diminishing the mortality rate and mutilation rate. Appropriate ad-junctive therapy can dramatically improve the curative effect.