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

Role of smear examination of wound secretion in early diagnosis and treatment of gaseous gangrene after trauma

目的探讨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。方法回顾性分析2003年4月至2006年4月本院收治的受伤后超过1 h的10 881例开放性创伤患者的资料,对其伤口分泌物早期常规作革兰染色涂片检查。结果本组创伤患者发生气性坏疽11例,发病率为0．10%。其中车祸伤5例,机器压伤3例,石头压伤2例,枪伤1例。受伤部位在上肢7例(63．6%),下肢3例(27．3%),下颌部合并头颈部伤1例(9．09%)。发病时间(3．3±2．2)d,均全部治愈。7例合并粉碎性骨折、已丧失肢体功能的患者均行伤肢截肢,3例肢体创伤没有骨折的患者及1例下颌部合并头颈部伤气性坏疽立即行外科清创、联合选用抗菌谱广(包括革兰染色阳性和阴性)的头胞菌素和高压氧治疗后均治愈。结论气性坏疽发生率少但比较致命,医生诊断时应提高警惕。清洗和清创术对预防感染是关键,高压氧是一种有益的辅助治疗。早期伤口分泌物涂片查找革兰染色粗大杆菌对早期诊断创伤性气性坏疽有一定的作用,且快速简便。

Objective To investigate the role of smear examination of wound secretion in early diagnosis and treatment of gaseous gangrene after trauma. Methods The data of 10 881 patients, who were carried to our hospital more than one hour after injuries from April 2003 to April 2006, were collected. Smear examination of wound secretion had been performed in these patients. Results Among the 10 881 wounded patients, 11 patients developed gaseous gangrene, taking up 0.10%. Among the 11 gaseous gangrene patients, 5 were caused by vehicle crash , 3 by machine, 2 by stone, 1 by gun - shot injury. As for the wounded locations, 7 （63.6%） patients were in lower extremity, and 3 （27.3%） patients in upper extremity, and 1 patient in mandible with head and neck wounds. The onset time of gaseous gangrene was （3.3± 2.2） d . The 11 patients were completely cured. Seven patients with open comminuted fracture and lost limb function were performed with wound limb amputation, 3 patients with injuries without fractures and 1 patient with mandible combined head and neck wounds were immediately treated with surgical debridement, cephalosporins, and hyperbaric oxygen （HBO）. Conclusion Gas gangrene was extremely rare in injury patients but it was life - threatening, so doctors should pay more attention. Cleaning- up the wounds and debridement were critical for prevention of infection, and HBO might serve as an useful assistant method. Smear examination of wound secretion was helpful in early diagnosis and treatment of gaseous gangrene after trauma.