嚴重?zé)齻笊铎o脈導(dǎo)管相關(guān)感染并發(fā)顱內(nèi)多發(fā)性膿腫一例(完整版)
【正文】 灶清除術(shù)帶來困難，因此，有作者認為，留置導(dǎo)管時應(yīng)盡量避免使用深靜脈[4]。燒傷后并發(fā)顱內(nèi)感染雖然較少見，但仍有病例報道[1]，多見于兒童,成人也可發(fā)生。入院后20h,患者面頸部、雙前臂腫脹明顯,自訴喉頭有異物感及雙手指麻木等不適,遂于局麻下行氣管切開,雙上肢燒傷皮膚及淺筋膜切開減壓術(shù),隨后病情平穩(wěn)。入院后行右側(cè)股靜脈穿刺置管常規(guī)液體復(fù)蘇、創(chuàng)面清創(chuàng)，頭面部暴露,四肢及軀干創(chuàng)面外用1%磺胺嘧啶銀霜包扎等治療。譯文： The patient, male, 36 years old, was sent to hospital 3 hours after he was burnt by flame all over his on admission: ℃, P96 times/min, R 22 times/min, patient was in ordinary condition with conscious mind and smooth breath. The burnt wound spreads in head, neck, body and 4 base of burnt wound was mostly yellowish on admission: ①Total burnt area 35%, II degree superficial burn 15%, II degree deep burn 20%. After admission, the patient received treatment of indwelling catheter by right femoral vein puncture conventional fluid resuscitation, wound debridement, head and face exposure, 4 limbs and body wound bound up externally with 1% density sulfadiazine silver frost, etc. 20 hours after admission, patient’s face, neck and both forearms were obviously swelling. He plained there was malaise feeling of foreignbody sensation in throat and numbness in both hands fingers. So tracheotomy, burnt skin of both arms and superficial fascia incision release were carried out. Then the patient’s condition was improving. 5 days after injury, 15% of both arms, left calf II degree deep burnt wound scab excision and meshed autogenous skin transplantation were carried out under intravenous anaesthesia. After operation, cefoperazone and etimicin were used to prevent infection, and 1% density sulfadiazine silver frost was still applied externally in II degree deep burnt face wound and body wound which would be refreshed on alternate days. Bacteria was not cultured from wound secretion. 5 days after operation, medicine was refreshed for scab excision and skin grafting skin graft flap was well developed. 14 days after injury trachea cannulas was pulled off and the patient could breathe smoothly and condition was stable. All wound areas were healed except 1% of II degree deep burnt wound in right lower abdomen and left dorsalis treatment, since 11 days after injury, patient was found have high fever, and the highest temperature could reach ℃,the number of peripherial leucocytes amounted to 109/L with centriole 76%. The adjusting anti
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