Mokoena T, Hadley G P
Department of General Surgery, University of Natal, Durban.
S Afr Med J. 1991 Aug 17;80(4):185-8.
Multiple limb gangrene and auto-amputation without arterial vascular occlusive disease is uncommon. Seven such paediatric patients were managed at King Edward VIII Hospital, Durban, during the 6-year period ending in 1989. The spectrum and degree of limb gangrene ranged from phalangeal necrosis to distal limb mummification affecting one or more limbs. The most affected child had gangrene and mummification of all limbs as well as gangrene of the ear lobes and the tip of the nose. The main associated factor was severe fluid loss--2 children had received herbal enemas, with resultant hypotension, hypoperfusion, hypernatraemia and acidosis, which, it is postulated, led to peripheral thrombosis and the ensuing gangrene. It is suggested that aggressive fluid therapy, including low molecular weight dextran and correction of the metabolic derangement, should form the main thrust of the therapeutic endeavour. Once gangrene is established, surgical debridement and rehabilitation is all that is possible. Using this procedure only 2 patients died in the acute resuscitation phase.
无动脉血管闭塞性疾病的多发性肢体坏疽和自行截肢并不常见。在德班爱德华八世医院，1989年结束的6年期间共收治了7例此类儿科患者。肢体坏疽的范围和程度从指骨坏死到影响一个或多个肢体的远端肢体干尸化不等。病情最严重的患儿四肢均发生坏疽和干尸化，同时耳垂和鼻尖也出现坏疽。主要相关因素是严重的液体丢失——2名儿童接受了草药灌肠，导致低血压、灌注不足、高钠血症和酸中毒，据推测，这导致了外周血栓形成及随后的坏疽。建议积极的液体疗法，包括使用低分子右旋糖酐和纠正代谢紊乱，应成为治疗努力的主要方向。一旦坏疽形成，手术清创和康复是唯一可行的措施。采用这种方法，只有2例患者在急性复苏阶段死亡。
