Berg A, Aas P, Lund T
Fysiologisk Institutt Universitetet i Bergen, Arstadveien 19, Bergen.
Tidsskr Nor Laegeforen. 1999 Jan 30;119(3):382-5.
Frostbite injuries occur mainly in toes, fingers, ears, nose and cheek. Typically an initial vasoconstriction in the skin will protect from drop in core temperature. Ice crystal development occurs when tissue temperature drops to -2 degrees C, leading to increased osmolality of the extracellular fluid and intracellular dehydration. An additional insult occurs with thawing due to reperfusion of the tissue and thereby release of inflammatory mediators. Symptoms of frostbite injury are: White-cyanotic discoloration, pain and numbness followed by hypoaesthesia. General hypothermia should be prevented and treated before managing the local frostbite injuries. Direct contact with warm skin without rubbing should be used in superficial injuries. More severe and deeper injuries should not be thawed until definite treatment could be given in a hospital. Re-freezing and mechanical influence on the injured parts must be avoided. Thawing should preferably be done in stirred water of 40-42 degrees C with mild soap. Antibiotics may be indicated when the skin barrier is broken. Surgical debridement should be postponed until a clear demarcation occurs.
冻伤主要发生在脚趾、手指、耳朵、鼻子和脸颊。通常，皮肤最初的血管收缩会防止核心体温下降。当组织温度降至-2摄氏度时，冰晶形成，导致细胞外液渗透压升高和细胞内脱水。解冻时，由于组织再灌注并由此释放炎症介质，会造成额外损伤。冻伤的症状包括：皮肤呈白青色、疼痛、麻木，随后感觉减退。在处理局部冻伤之前，应预防和治疗全身性体温过低。对于浅表冻伤，应采用与温暖皮肤直接接触而不揉搓的方法。对于更严重和更深层的冻伤，在医院能够进行明确治疗之前不应解冻。必须避免受伤部位再次冷冻和受到机械影响。解冻最好在加了温和肥皂的40-42摄氏度搅拌水中进行。当皮肤屏障受损时，可能需要使用抗生素。手术清创应推迟至出现明确分界后进行。
