胸腹腔开放性高压电烧伤并发过敏紫癜性肾炎的救治

Treatment of thoracic and abdominal cavity perforation complicated by Henoch-Schonlein purpura nephritis in a patient with high-voltage electric burn

1病历摘要患者男，55岁，躯干、左上肢接触10万V高压电致伤，伤后13h人院。入院时患者精神差、烦躁，呕吐少量咖啡色胃内容物，小便酱油色、量少。左前臂中上1／3以远坏死，右侧躯干及全腹壁皮肤、肌肉组织炭化，第7—10肋骨外露坏死，腹直肌外露呈熟肉样，中上腹壁有3处开裂，部分肠管外露呈暗红色，创面肿胀伴渗出（图1）。

A 55-year-old male patient suffered from se- vere high-voltage electric burn with an area of 20% TBSA full- thickness injury. The injury involved the distal end of left upper llmb, right trunk, and whole abdominal wall. Fracture of the 7th-10th ribs was found in the right side of chest, with perfora- tion of abdominal cavity, and bilateral pleural effusion was found. Part of the small intestine was necrotic and exposed. At the early stage, xeno-acellular dermal matrix was grafted after debridement of abdominal wound; peritoneal lavage was per- formed; negative pressure drainage was performed in orificium fistula of intestine for promoting the adhesion between perforated intestine and abdominal scar. Two orificium fistulas formed after closure of abdominal granulation wound by autologous skin graft- ing. Eschar of chest wall and denatured ribs were retained. The risk of infection of thoracic cavity was decreased by promoting the adhesion between lung tissue and chest wall. During the treatment, the patient was diagnosed with Henoch-Schonlein purpura nephritis by renal biopsy, with the symptoms of purpura in the lower limbs, heavy proteinuria, severe hypoalbuminemia, edema, etc. After control of kidney damage by immunosuppres- sive treatment instead of glucocorticoid, alleviation of the levels of proteinuria and blood albumin, free latissimus dorsi myocuta- neous flap was excised to repair chest wall, and free skin graft was excised to repair intestinal fistula. After all the wounds were successfully covered, the patient was treated with glucocorticoid combined with immunosuppressants for more than 1 year. The patient was followed up for 3 years, and his renal function was completely recovered with satisfactory clinical outcome.