Royal Cornwall Hospitals NHS Trust, United Kingdom.
Royal Cornwall Hospitals NHS Trust, United Kingdom.
Wilderness Environ Med. 2022 Sep;33(3):344-347. doi: 10.1016/j.wem.2022.04.009. Epub 2022 Jul 12.
Nonfreezing cold injury (NFCI) is caused by prolonged exposure to cold, usually wet conditions and represents a separate pathological entity from frostbite. The pathophysiology of NFCI is characterized by vasoconstriction and microcirculatory disturbance. Iloprost, a synthetic prostaglandin analogue with vasodilatory properties is a recognized adjuvant treatment in frostbite; however, its role in NFCI is unclear. We present a case of a 29-y-old man with severe NFCI to both forefeet after prolonged immersion in cold seawater. Initial treatment with passive rewarming, analgesia and aspirin was initiated. Infusion of iloprost was used within 24 h from presentation and was well tolerated. This resulted in reduced tissue loss compared to the apparent tissue damage documented during the initial assessment. Delayed surgical intervention allowed minor debridement and minor toe amputations, maintaining the patient's ability to ambulate. This case demonstrates the safe use of iloprost in acute NFCI and highlights the importance of delayed surgical intervention in patients presenting with severe NFCI.
非冻结性冷伤（NFCI）是由长时间暴露于寒冷、通常是潮湿的环境中引起的，与冻伤是不同的病理实体。NFCI 的病理生理学特征是血管收缩和微循环障碍。前列地尔是一种具有血管扩张作用的合成前列腺素类似物，已被确认为冻伤的辅助治疗药物；然而，其在 NFCI 中的作用尚不清楚。我们报告了一例 29 岁男性，因长时间浸泡在冷海水中，双脚前足严重冻伤。最初采用被动复温、镇痛和阿司匹林进行治疗。在发病后 24 小时内使用前列地尔输注，患者耐受性良好。与初始评估期间记录的明显组织损伤相比，这导致组织损失减少。延迟手术干预允许进行小面积清创和小趾截肢，保持了患者的步行能力。该病例证明了在急性 NFCI 中使用前列地尔是安全的，并强调了在严重 NFCI 患者中延迟手术干预的重要性。
