Chen Enqiang, Deng Linyu, Liu Zigui, Zhu Xia, Chen Xuebing, Tang Hong
Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, 610041, China.
Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, 610041, China.
J Huazhong Univ Sci Technolog Med Sci. 2011 Feb;31(1):83-87. doi: 10.1007/s11596-011-0155-3. Epub 2011 Feb 19.
Gas gangrene is an emergency condition, which usually develops after injuries or surgery. This study was designed to investigate clinical characteristics, appropriate therapy, and effective control of nosocomial cross-infection of gas gangrene in Wenchuan earthquake victims. Data on diagnosis, treatment, and prevention of confirmed, suspected, or highly suspected gas gangrene were collected. Sixty-seven (2.41%) cases of suspected gas gangrene were found, in which 32 cases were highly suspected of gas gangrene and 5 cases were confirmed by culture of Clostridium perfringens. Thereof, injury sites were mainly located on the limbs, and typical indications, including crepitation, severe localized pain, swelling, wound discoloration, dark red or black necrotic muscle, foul smell as well as different degrees of systemic toxic performance were common among them. After hospitalization, all patients were isolated and had surgery quickly to remove dead, damaged or infected tissue. The wounds were also exposed for drainage and washed or padded with 3% liquid hydrogen peroxide for disinfection before all diagnostic test results were available. Additionally, high doses of antibiotics (mainly penicillin) were given for the prevention of infection, and supportive therapy was applied for corresponding symptoms control. Among those cases, no fatality was reported. In summary, in post-disaster emergency relief, the diagnosis of gas gangrene should be primarily based on clinical manifestations; while patient isolation, wound debridement and disinfection, as well as antibiotics treatment, is the main measures for proper treatment and control of nosocomial infection for gas gangrene.
气性坏疽是一种紧急情况，通常在受伤或手术后发生。本研究旨在调查汶川地震受害者气性坏疽的临床特征、适当治疗方法以及医院内交叉感染的有效控制措施。收集了确诊、疑似或高度疑似气性坏疽的诊断、治疗和预防数据。发现67例（2.41%）疑似气性坏疽病例，其中32例高度疑似气性坏疽，5例通过产气荚膜梭菌培养确诊。其中，损伤部位主要位于四肢，典型表现包括捻发音、严重局部疼痛、肿胀、伤口变色、暗红色或黑色坏死肌肉、恶臭以及不同程度的全身中毒表现。住院后，所有患者均被隔离并迅速进行手术，切除坏死、受损或感染组织。在所有诊断测试结果出来之前，伤口也进行暴露引流，并用3%过氧化氢溶液冲洗或湿敷进行消毒。此外，给予高剂量抗生素（主要是青霉素）预防感染，并针对相应症状进行支持治疗。这些病例中无死亡报告。总之，在灾后紧急救援中，气性坏疽的诊断应主要基于临床表现；而患者隔离、伤口清创消毒以及抗生素治疗是气性坏疽正确治疗和控制医院感染的主要措施。
