严重电击伤51例治疗分析  

Treatment analysis of 51 cases with severe electrical injury

作　　者：祁少海[1] 黎志明[1] 利天增[1] 

机构地区：[1]中山医科大学附属第一医院烧伤科,510080

出　　处：《新医学》1998年第12期629-630,651,共3页Journal of New Medicine

摘　　要：目的 :探讨严重电击伤的手术时机 ,术前创面处理和皮瓣的选择。方法 :对 5 1例严重电击伤的临床资料进行分析。结果 :5 1例均行手术治疗 ,其中截肢 32例 ,植皮修复 34例 ,皮瓣移植修复 31例。头面部手术均在受伤 7天后进行。受伤 7天内四肢植皮 8例 ;7天后经创面处理再植皮 2 6例 ,其中头面部 18例 ,四肢 8例 ,34例植皮均成活。受伤 7天内四肢皮瓣移植成活率 67% (12 /18) ,7天后的皮瓣移植经术前创面处理成活率 77% (10 /13) ,P>0 .0 5 ,其中头面部 6例成活 5例 ,四肢 7例成活 5例。用远位带蒂皮瓣修复的 6例均成活 ,而用邻近随意皮瓣修复的成活率仅 61% (14/2 3)。头面部伤在伤后 10～ 14天手术 ;四肢伤创面无感染者在伤后 3～ 7天手术 ;受伤 7天以后的创面有感染者经过适当术前创面处理后再手术 ;腹部伤有急腹症早期表现时立即剖腹探查均取得较好的临床疗效。结论 :掌握不同部位的手术时机、采用适当的术前创面处理和选用合适的皮瓣修复创面是治疗严重电击伤成功的关键。Objective:To study the suitable operation time,wound management before operation and flap selection in severe electrical injury Method:The clinical data of 51 cases with severe electrical injury were analysed Results:51 cases were operated,including 32 amputations,34 skin allografts,31 flap grafts. The operations in head were performed beyond 7 days after injury,8 skin allografts in extremities were accomplished within 7 days after injury 26 skin allografts were performed after wounds treatment beyond 7 days after injury,including 18 cases in head and face,8 in extremities All 34 allografts were alive The surival rate of flaps in extremities within 7 days after injury was 67%(12/18),and the surival rate of flap beyond 7 days after injury was 77%(10/13),including 5 of 6 cases in head,5 of 7 cases in extremities There was no significant difference between the two groups ( P >0 05) All 6 cases with distant pedicle flaps were alive,but only 61%(14/23) of local flaps were alive The suitable operation time for electrical injury in head was 10～14 days after injury,3～7 days for uninfected wounds in extremities The infected wounds beyond 7 days after injury should be properly treated before operation Laparotomy was immediately performed once early signs of acute abdomen appeared Great clinical effects were acquired so long as operations were performed at suitable time Conclusion:Adequate operation time and wound treatment before surgery and porper flaps were the key to the sucessful treatment of severe electrical injury

关 键 词：电击伤 治疗 皮瓣选择 

分 类 号：R647.05[医药卫生—外科学]