持续高锰酸钾冲洗联合负压封闭引流术治疗创伤性气性坏疽临床疗效观察

Vacuum sealing drainage with continuous irrigation of potassium permanganate to treatment traumatic gas gangrene

目的 观察持续高锰酸钾冲洗＋负压封闭引流术（VSD）治疗创伤性气性坏疽的临床疗效和应用价值。方法 2011年6月—2015年11月华中科技大学同济医学院附属协和医院骨科采用高锰酸钾持续冲洗联合VSD治疗创伤性气性坏疽42例,其中24例患者行截肢手术,18例患者行保肢治疗。所有患者在截肢术或扩大清创术后,伤口均给予1：5 000的高锰酸钾持续冲洗联合VSD控制感染,对所有患者治疗前后的病情恢复程度进行评价。结果随访8~20个月,中位时间14个月,所有患者均无复发,伤口愈合良好。其中1例患者因严重的失血性休克致术中发生心脏骤停,紧急心肺复苏后恢复良好;3例患者为混合性感染,给予多次扩大清创术控制感染;4例患者截肢术或扩大清创术后出现严重的疼痛,经治疗后缓解。2例挤压综合征患者因肾功能衰竭给予透析治疗。全部患者均无系统性高锰酸钾吸收。结论 持续高锰酸钾冲洗联合VSD是治疗创伤性气性坏疽的有效治疗方式,值得推广。

Objective To observe the clinical curative effect and application value of continuous flush of potassium permanganate combined with vacuum sealing drainage （VSD）.Methods From June 2011 to November 2015, 42 patients of traumatic gas gangrene have been treated were enrolled in this study , among which , 24 patients were cured with amputation , the others were treated with limb salvage procedures .After amputation or limb salvage procedures , the wound of all patients were disposed of continuous flush of 1∶5 000 potassium permanganate solutions with VSD to control infection .Then evaluate the illness recovery degree of all patients after treatment .Results The follow up visit range from 8 to 20 months （ average 14 months ） , none of the patients relapse and the wound healed well .Sudden cardiac arrest during surgery occurred in one patient who suffered from severe hemorrhagic shock .Recovering well was found in patients after urgent cardio pulmonary resuscitation （CPR）.Three patients suffered from mixed infection, which get well by several extensive debridement .Four patients suffered from severe pain after amputation or extensive debridement , which became well after treatment .Two patients of crush syn-drome accepted dialysis for concomitant renal failure .Conclusion Continuous flush of potassium permanganate combined with VSD system is a effective therapy method for traumatic gas gangrene .