海洋生物刺伤致手部慢性感染的治疗  

Treatment of hand chronic infection by marine biological damage

作　　者：陈昌伟[1] 徐杏平[1] 周磊[1] 

机构地区：[1]解放军第113医院骨科,浙江宁波315040

出　　处：《临床军医杂志》2013年第2期148-150,共3页Clinical Journal of Medical Officers

摘　　要：目的探讨海洋生物刺伤致手部慢性感染的发病机制及治疗效果。方法对38例手部慢性感染患者依据症状的轻重不同采取药物治疗、局部理疗等非手术治疗以及以手术为主的彻底清创,配合局部理疗、药物及高压氧等综合治疗。结果 17例症状较轻病例行非手术治疗,15例获得6～12月随访,均获痊愈,手部功能无明显障碍。21例手术病例经随访5～16个月,其中2例于术后3、5月局灶性复发,行二次手术治疗获痊愈。伤手按TAM评定:优11例,良5例,可3例,差2例。结论海洋生物刺伤致手部感染是一种特殊性的感染,其发病与分枝杆菌感染关系密切,根据症状不同,可以采取非手术及手术治疗等综合措施,选用克拉霉素或罗红霉素+利福平+乙胺丁醇,连续治疗3～6月化疗方案可取得良好的疗效。Objective To investigate the pathogenesis of chronic infection caused by marine biological wound in the hand, and to explore the therapeutic effect of various methods. Methods A total of 38 patients with hand chronic infection caused by marine organisms were treated with non-surgical treatment（ drug chemotherapy and local physiotherapy）and surgical radical debridement cooperating with other treatment（ local physiotherapy, drugs therapy, hyperbaric oxygenation, and so on） according to the severity of symptoms. Results Non-surgical treatment was applied to the 17 patients with mild symptoms, among whom 15 ones got full recovery without obvious obstacle of hand function during 6 to 12 months＇ follow-up. The other 21 ones underwent surgical treatment and were followed up for 5 - 16 months. In the 21 ones,2 replapsed in 3 through 5 months and recovered after the second surgery. Also in the 21 ones in the end, the therapeutic outcomes were excellent in 11, good in 5, so-so in 3 and poor in 2 ones by TAM evaluation of hand injury. They all had their infection controlled and returned daily work and life. Conclusion The hand infection caused by marine orgabnisms stabbing is a particular disorder, whose onset is closely related with mycobacterium infection. Non-surgical and surgical treatments may be applied to the patients with the infection according to different symptoms. Clarithromycin or Roxithromycin plus Rifampicin and Ethambutol continuous treatment for 3 - 6 months have a good effect.

关 键 词：海洋生物伤 手部感染 分枝杆菌 

分 类 号：R658.2[医药卫生—外科学]