对电击伤并大面积电弧烧伤抢救35天的体会

35 Day Rescue of A Case of Electric Shock and Large Area Electric Arc Burn

本文报道了采用湿润暴露疗法治疗一例电击伤并大面积电弧烧伤抢救35天的体会与教训,试图通过分析为今后救治此类患者提供参考。通过分析总结提出对电击伤并大面积深度烧伤病人休克期应加大输液量、及等比例胶晶液体、早给硷性药物及利尿剂,以维持高尿量的情况下,注意水电解质平衡紊乱的发生;早期重视多脏器功能损害并发症的预防和扶持免疫功能,及营养支持等是全身治疗的关键。指出该疗法创面治疗只要按照发明人的理论联系实际、在焦痂用“MEBO”软化的情况下以不损伤尚有活力的组织为原则,有计划地切除坏死组织、然后继续用“MEBO”对深度创面包括浅Ⅲ度的治疗效果良好,愈后无疤痕或少量疤痕。并提出在病人情况差而创面感染不明显、病灶不明确的情况下,无选择地彻底清创值得商榷。因此时对清创难以达到理想的目的,而手术本身创伤颇重、可能会使已经危重的病情恶化。除非病灶明确、可施行彻底清创外,否则弊大于利。通过大量的事实现察分析提出严重电击伤病人有迟发性脑损害,这可能是致死的重要因素之一,临床应加以注意。

This paper deals with the experience of a 35 day rescue of a case of electric shock and large area electric arc burn and the lessons drawn therefrom. The authors conclude through analysis that the following are of great importance in the treatments. Additional amount of infusion containing equal proportions of colloids and crystals should be given to patients with electric shock and large area electric burn and early administrations of basic drugs and diuretics to maintain large urine volume are advisable. Attention should be paid to check the disturbance of the balance of electrolytes. Take early measure to prevent complications of injuries of the function of multiple organs and to support immunity. Ample nutrition supply is also indispensable. The authors point out that persistent applica-tion of MEBO to deep burn wounds including third-degree bums will result in good healing with no or very few scars, as long as the doctors adhere to the principles instructed by the inventor of the MEBT and apply them correctly to their practice. Patients can be healed by applying MEBO to the erchars. Necrotic tissue is excised in a planned way, taking care not to injure the vital tissue during operation. The authors also point out that the performance of thorough debridement without discrimination of the cases is a point open to question. For patient of bad health condition with no distinct focus of infection, thorough debridement should be done only after delibera-tion. Because in such a case, debridement usually gives unsatisfactory results and the operation itsself will make harm to the wounds and even make the condition worse. Unless the focus of in-fection is distinct, thorough debridement has its disadvantage outweighing its advantage. The au-thors suggest that the main cause of death of the severe electric shock may be tardy brain injury. Doctors should take precautions against it.