时间 : 2009-12-08 01:50:05 来源:www.wooyao.org.cn
患者左足电击伤一天入院,经过两天的术前预备后行左足清创扩创探查术,术中见大量血管栓塞,肌肉、肌腱坏死,胫骨、跖骨外露,触足趾远端冰凉。现患者足末端已坏死,肌肉大量坏死液化(入图所示)求助最佳治疗方案。
LDF值小于2.5,微血管扩张值小于0.5为深II度烧伤;LDF值小于1.5,微血管不扩张为III度烧伤)后两种方法较客观、准确,但需一定的设备和条件,一般不轻易实现;相对来说,美蓝染色临床应用较多,便宜、方便,若组织尚存活力,可再此手术时应用。此引入一相对简单的图像判定法CASEREPORTLichtenbergfigures:cutaneousmanifestationofphoneelectrocutionfromlightning*AjayLMahajana,b,*,RuchikaRajanb,PadraicJReganaaDepartmentofPlastic,Reconstructive&HandSurgery,UniversityCollegeHospital,Galway,IrelandbDepartmentofPlasticandReconstructiveSurgery,DerrifordHospital,Plymouth,UKReceived29November2006;accepted19June2007SummaryIntroduction:Lichtenbergfiguresarereddish,fern-likepatternsthatappearontheskinwhenapatientisstruckbylightning.Theseappeartobearesultofaninflammatoryresponseascurrentspreadsoutcausingionisationandheateffectsanddamagetothesmallsubcutaneouscapillaries.CasereportA30-year-oldladywasbroughttoouraccidentandemergencydepartmentwithahistoryofmomentarylossofconsciousness.Onarrival,thepatientwasfullyconsciouswithaGlasgowcomascaleof15.Shewascomplainingofaheadacheandtinnitusinherrightear.Shealsohadparaesthesiaontherightsideofherface,neck,chest,bothhandsandrightleg.Shewasveryanxiousandwasexperiencingpalpitations.Allthatthepatientcouldrecollectwasthatshehadbeenonthephonewhensheheardaloudbangfollowingwhichshe‘blackedout’.Whensheregainedconsciousness,shefoundherselflyingonthefloor,afewfeetawayfromthetelephone.Shefeltaburningsensationandparaesthesia,mainlyontherightsideofherbody.Theburningsensationhadresolvedbythetimeshehadpresentedtous,1haftertheincident.Theweatherhadbeenquitestormyonthedayandoninspectionofthepatient,therewerecharacteristicerythematousLichtenbergfiguresontherightsideofherneck,chest,abdomen,bothupperlimbsandrightlowerlimb(Figs.1and2).Theserevealedthetruediagnosisofalightningstrikeconductedthroughthephonelineintothepatient.Thepatientwasfoundtohaveanincreasedrespiratoryrateandpulserate.Anelectrocardiogramexaminationshowednoevidenceofarrhythmia.Neurologicalexaminationwasnormalwithfullpowerinallthelimbs.Therewasnoevidenceofanexitburnwound.Examinationoftheearsshowedaperforationintherighttympanicmembraneandtestsconfirmedasensorineuraldeafnessonthatside.Examinationoftheeyeswasnormal.Thepatienthadnootherassociatedinjuries.Shewasadmittedforobservationanddischargedthefollowingday.TheLichtenbergfiguresresolvedwithin24h.Shewasquitetraumatisedbytheeventandreceivedpsychiatriccareasshewasemotionallyverylabile.Theperforatedtympanumhealedwithconservativemanagementinafewweeksandthepatienthadsomedegreeofresidualsensorineuraldeafnessather6monthfollowup.DiscussionInjuryfromalightningstrikecanoccureitherbyadirectstrike,sidesplash(whenlightningsplashesontosomeonestandingclosetoanobjectstruckbylightning)orbystepvoltage(whencurrentflowingintheground,followingalightningstrike,goesuponelegandconductsbackdowntheother!).1CutaneousmanifestationsrangefromsimpleLichtenbergfigurestofullthicknessburns.Lichtenbergfiguresarefern-likepatternsduetohighvoltagedischarges,firstdescribedbytheGermanphysicistGeorgChristophLichtenberginthelate1700s.2Thesearesaidtooccurduetoaninflammatoryresponseascurrentspreadsoutcausingionisationandheateffects.3Injurytothesubcutaneouscapillariesisthoughttooccur.Thesesignsgenerallyresolvewithin24hbutcanoccasionallybeassociatedwithdeeppigmentation.Dependingontheamperageofthecurrentpassingthrough,thepatientmayhavemildeffectssuchasparaesthesiaatlowamperages,whichcanprogresstotetany,respiratoryarrestorcardiacarrestfollowingventricularfibrillationsathigheramperage.4Adirectlightningstrikecanexposethepatienttocurrentsrangingfrom3kAtoover100kA.5Whenthecurrentpassesthroughthebody,thepathwayofleastresistanceappearstobethetympanicmembraneandoftenthetympanicmembraneisfoundtoberuptured.6Damagetothemiddleearmayresultinthepatientexperiencingtinnitus,ataxia,vertigoandnystagmus.Visuallosscanoccurforvaryingdurations,occasionallyfromformationofcataracts.Injuriestothecentralnervoussystemcanresultinhaemorrhage,infarction,oedemaandnecrosisofthebrainleadingtomotorandsensorydysfunctionanddelayedprogressiveneurologicaldamage.7Charcot’sparalysisorkeraunoparalysis,whichischaracteristicoflightninginjuries,canaffectallthelimbstemporarilyandresolvesgradually.8Dependingonthedegreeoftheassault,patientsmaysufferfromretrogradeamnesia,confusion,anxiety,andpsychoticbehaviour,oftenneedingpsychiatrichelp.
Copyright© 2000-2015 www.9939.com All Rights Reserved 版权所有 皖ICP备18005611号-7
特别声明:本站信息仅供参考 不能作为诊断及医疗的依据 本站如有转载或引用文章涉及版权问题请速与我们联系