创面分泌物涂片检查在开放性地震伤气性坏疽诊治中的运用
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摘要
目的探讨创面分泌物涂片检查在开放性地震伤气性坏疽诊治中的作用。方法开放性地震伤患者入院后均常规行伤口分泌物细菌学涂片筛查,怀疑气性坏疽者立即予以隔离,并视病情采取相应手术和抗感染治疗。创面处理后再次行分泌物涂片筛查,阳性者予以再手术治疗。结果对376例开放性损伤468次创面分泌物涂片,结合临床诊断为气性坏疽者25例,其中初次涂片结果显示革兰阳性(G~+)粗大杆菌20例,培养确认气性坏疽杆菌者12例(包括5例涂片阴性者);创面处理后分泌物涂片显示仍有少量G~+粗大杆菌残留者12例,再次扩创后涂片未发现G~+粗大杆菌。截至2008年7月底,25例患者创面全部愈合。救治期间,在分诊时即诊断出气性坏疽,无漏诊和医院感染病例发生。结论在发生大面积开放性创伤患者聚集时,合理使用创面分泌物涂片检查,有助于及时、准确筛查出创伤性气性坏疽,提高治疗效果并防止医院感染。
Objective To evaluate the role of smear examination of wound secretion in diagnosis and treatment of gaseous gangrene in open earthquake injury.Methods Smear bacteriological examination of patients'wound secretion were performed,patients who were suspected gaseous gangrene were isolated,operation and anti-infection treatment were offered according to patients'condition.Further smear were performed after the wound were treated, and patients with positive smear results received operation on wound.Results 468 wound smear bacteriological examination were performed in 376 patients,25 patients were diagnosed as gaseous gangrene combined with clinical manifestations,20 of 25 showed enlargement of gram-positive bacilli at initial smear,12 of whom were confirmed by bacterial culture as gaseous gangrene(including 5 cases of negative smear);another 12 patients remained positive by smear examination of exudation after treatment,and no gram-positive bacilli was found after re-debridement.The wounds of 25 patients infected by gaseous gangrene have been healed by the end of July,2008.During the period of earthquake remedy,all gaseous gangrene were diagnosed in emergency department,no missed diagnosis,and no nosocomial infection.Conclusion Smear examination of wound secretion is helpful in the diagnosis of gaseous gangrene promptly,conveniently and accurately,which can improve the effects of treatment,and reduce nosocomial infection rate.
Objective To evaluate the role of smear examination of wound secretion in diagnosis and treatment of gaseous gangrene in open earthquake injury.Methods Smear bacteriological examination of patients'wound secretion were performed,patients who were suspected gaseous gangrene were isolated,operation and anti-infection treatment were offered according to patients'condition.Further smear were performed after the wound were treated, and patients with positive smear results received operation on wound.Results 468 wound smear bacteriological examination were performed in 376 patients,25 patients were diagnosed as gaseous gangrene combined with clinical manifestations,20 of 25 showed enlargement of gram-positive bacilli at initial smear,12 of whom were confirmed by bacterial culture as gaseous gangrene(including 5 cases of negative smear);another 12 patients remained positive by smear examination of exudation after treatment,and no gram-positive bacilli was found after re-debridement.The wounds of 25 patients infected by gaseous gangrene have been healed by the end of July,2008.During the period of earthquake remedy,all gaseous gangrene were diagnosed in emergency department,no missed diagnosis,and no nosocomial infection.Conclusion Smear examination of wound secretion is helpful in the diagnosis of gaseous gangrene promptly,conveniently and accurately,which can improve the effects of treatment,and reduce nosocomial infection rate.
引文
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[2] 白涛.现代创伤诊断学[M].北京:人民军医出版社,1996:7．
[3] 陈庆永,王春友.早期伤口分泌物涂片检查对创伤性气性坏疽 早期诊断的作用[J].中华急诊医学杂志,2006,15(9) :781-783．
[4] 缪春勤,李鲁,胡国忠.医院医疗资源整合在台风伤害中临床急救效果评估[J].中国卫生事业管理,2007,11:739-742．
[5] Takahira N,Shindo M,Tanaka K,et al.Treatment outcome of nonclostridal gas gangrene at a level 1 trauma center[J].J Orthop Trauma,2002,16(1) :12-17．
[6] Winter E,Dommke A,Bongers-Binder S,et al.Exogenously acquired Clostridium sept icurn gas gangrene-a case report[J].Swiss Surg,1998(6) :316-318．
[7] Kuroda S,Okada Y,Mira M,et al.Fulminant massive gas gan grene caused by Clostridium perfringens[J].Intern Med,2005,44(5) :499-502．
[8] Nancy F.Infectious myositis[J].Best Practice and Research Clinical Rheumatology,2006,20(6) :1083-1097．
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