Bunt T J
Division of Vascular Surgery, Maricopa Medical Center, Phoenix, Arizona 85010.
Am Surg. 1990 Sep;56(9):530-2.
There are three options for management of pedal sepsis requiring lower extremity amputation: one-stage emergency, two-stage guillotine, or physiologic amputation. The excessive mortality usually ascribed to amputation surgery is basically derived from the selection of one of these options in emergency situations, with published mortalities of 10 per cent to 40 per cent being the norm. We have performed 465 lower-extremity amputations for vascular insufficiency for seven years, with overall 30-day operative mortalities of 0.5 per cent for below-knee amputations and 2.7 per cent for above-knee amputations. One hundred sixteen of these patients presented with acute pedal sepsis superimposed on significant medical disability, and were managed initially with physiologic amputation and intensive hemodynamic monitoring; the overall mortality for this select group was 5.1 per cent. An algorithm of management of patients presenting with acute pedal sepsis has thereby been derived, and is herein presented.
对于需要进行下肢截肢的足部脓毒症，有三种治疗选择：一期急诊手术、二期断头术或生理性截肢。通常归因于截肢手术的过高死亡率基本上源于在紧急情况下对这些选择之一的采用，公布的死亡率通常在10%至40%之间。我们在七年中为血管功能不全患者进行了465例下肢截肢手术，膝下截肢的30天手术死亡率总体为0.5%，膝上截肢为2.7%。其中116例患者同时患有急性足部脓毒症并伴有严重的内科残疾，最初采用生理性截肢和强化血流动力学监测进行治疗；这一特定组别的总体死亡率为5.1%。由此得出了针对急性足部脓毒症患者的治疗方案，并在此呈现。
