玉米联合收割机致手外伤的治疗

发布时间：2018-11-07 09:37

【摘要】：目的:近年来随着玉米联合收割机的普遍应用,此类机器所致手外伤也逐年增加,此类机器常有挤压,牵拉等多种致伤机制并存,且创面多被油污及植物碎屑严重污染,临床上此类外伤是较难治疗的一种外伤,且预后普遍较差,本研究对本地区玉米收割机所致手外伤的外伤特点、治疗规律及预后进行总结,对感染病原菌分布及感染因素进行调查分析,意在为临床医生接诊此类外伤患者时提供经验及科学依据。方法:选用2014年9月至2014年11月间我科两个病区收治的玉米联合收割机致伤患者共48例,男33例,女15例,年龄18-78岁,平均44岁。对本组患者进行回顾性调查与分析。对此类外伤的转归进行分类,总结外伤及治疗特点。对本研究中26例术后感染的患者感染的危险因素进行统计学分析。对细菌培养及药敏实验结果进行整理,分析感染原因并提出对策。结果:本组所有患者未出现死亡病例。均经过1-6次手术,平均3次手术的治疗,平均住院天数为55.3天。初次手术均为清创术,骨折和神经、肌腱、血管损伤均一期修复;皮肤缺损处理方式视创口污染情况而定,污染较轻者一期皮瓣覆盖,污染较重者早期应用可灌洗封闭式负压引流(VSD),二期皮肤移植覆盖。31例发生术后感染或坏死,17例未发生术后感染或坏死,感染坏死率64.6%,一次手术治愈率20.8%,需要多次手术治愈者38例,占79.2%。本地区此类外伤的常见病原菌为:铜绿假单胞菌。经卡方检验χ2=29.561,P=0.000。对玉米联合收割机致手外伤术后感染的危险因素的Logistic回归方程有统计学意义。结论:(1)玉米收割机伤多造成手部的严重损伤,是一种极难治疗和治愈的疾病,伤后预防和控制创面感染及组织迟发性坏死是治疗的难点。(2)玉米收割机伤后常有多种感染的危险因素共同存在,在诸多感染的危险因素中就诊时间、损伤程度、术后坏死、清创程度、手术时间等5项是具显著性意义的因素。这些是发生术后感染的主要因素,临床医师应该丰富经验提高手术水平,尽可能的降低易感因素的数量及水平。努力预防术后感染的发生(3)面对此类外伤主治医师应密切观察病情做好多次手术的心理准备,同时反复向患者及家属交代病情,使其做好长期治疗和患肢预后不良的心理准备,避免医疗纠纷发生。
[Abstract]:Objective: in recent years, with the widespread application of maize combine harvester, the hand injury caused by this kind of machine also increased year by year. There are many kinds of injury mechanisms such as squeezing, pulling and so on, and the wound surface is mostly polluted by oil and plant debris. Clinically, this kind of trauma is difficult to treat, and the prognosis is generally poor. This study summarized the characteristics, treatment rules and prognosis of hand trauma caused by corn harvester in this area. In order to provide experience and scientific basis for clinicians to receive such traumatic patients, the distribution of pathogenic bacteria and the factors of infection were investigated and analyzed. Methods: from September 2014 to November 2014, 48 patients (33 males and 15 females, aged 18-78 years, with an average age of 44 years) were treated by maize combine harvester in our department. The patients were retrospectively investigated and analyzed. The outcome of this kind of trauma is classified, and the characteristics of trauma and treatment are summarized. The risk factors of infection in 26 patients with postoperative infection were analyzed statistically. The results of bacterial culture and drug sensitivity test were analyzed and countermeasures were put forward. Results: there were no death cases in all patients. All patients were treated with 1-6 operations with an average of 3. The average hospital stay was 55.3 days. The first operation was debridement, and the fracture and nerve, tendon and vascular injury were repaired in one stage. The treatment of skin defect depends on the condition of wound contamination. The first stage skin flap covering with less contamination and the skin graft covering with (VSD), secondary skin graft with lavage and closed negative pressure drainage can be used in the early stage of serious contamination. Infection or necrosis occurred in 31 cases after operation. There were no postoperative infection or necrosis in 17 cases, the rate of infection and necrosis was 64.6%, the cure rate of one operation was 20.8%, 38 cases (79.2%) needed to be cured by multiple operations. The common pathogens of this kind of trauma in this area are Pseudomonas aeruginosa. Chi-square test showed that 蠂 2 was 29.561 and 0.000. The Logistic regression equation of infection after hand injury caused by maize combine harvester was statistically significant. Conclusion: (1) Corn harvester injury is a very difficult disease to treat and cure. Prevention and control of wound infection and delayed necrosis of tissue after injury are difficult points in the treatment. (2) there are many kinds of risk factors of infection after maize harvester injury. Postoperative necrosis, debridement and operative time were significant factors. These are the main factors of postoperative infection. Clinicians should improve the operation level and reduce the number and level of susceptible factors as much as possible. Try hard to prevent postoperative infection (3) in the face of this kind of trauma, the attending physician should closely observe the condition of the patient and make psychological preparations for many operations, and at the same time repeatedly explain the condition to the patient and his family. Make them prepare for long-term treatment and poor prognosis of the affected limb, to avoid medical disputes.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R658.2

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