gas gangrene
Introduction
Introduction to gas gangrene Gastric gangrene (Cytoplasmic muscle necrosis) is a serious infection caused by Clostridium exotoxin. It is characterized by muscle necrosis and systemic toxicity. It has an acute onset and rapid progress. The main pathogen is Clostridium perfringens (80%). about). Others include Clostridium botulinum, Novosporium, Clostridium difficile, Clostridium difficile and Clostridium clostridium. More than one kind of Clostridium or other bacterial infections may be combined. The infected bacteria are mostly from the soil, and the endogenous people are mostly from the intestines or biliary tract. Clostridium produces at least 12 exotoxins, which can be caused by intraperitoneal injection of 7 toxins. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: fecal mouth spread Complications: jaundice coma
Cause
Cause of gas gangrene
Pathogen infection (45%):
Clostridium is a Gram-positive anaerobic bacterium, which is mainly caused by Clostridium perfringens (Wei bacillus), edema and bacillus, followed by Bacillus bacillus and lytic bacilli. Gangrene, often a mixed infection of two or more pathogens. Clostridium is widely found in soil and human and animal feces, so it is easy to enter the wound, but it does not necessarily cause disease. The occurrence of gas gangrene is not solely determined by the presence of dysentery bacilli, but is determined by the body's resistance and wounds, that is, an anoxic environment that is conducive to the growth and reproduction of dystrophic gastrobacter. Therefore, water loss, massive blood loss or shock, but also a large area of tissue necrosis, deep muscle damage, especially thigh and buttock damage, shrapnel retention, open fracture or associated with major vascular injury, the use of tourniquet time is too long, etc. It is prone to gas gangrene.
Prevention
Gas gangrene prevention
Severe crush injuries and high-speed missile injuries are the most susceptible. The most important preventive measures are rapid and thorough expansion. All foreign bodies and non-viable tissues are removed. Fine hemostasis is also important. Deep irregular wounds must be maintained. Open, the wound site should not be tightly wrapped, should pay full attention to retain blood supply, improper use of tourniquet or tight plaster may cause adverse consequences, should be avoided, anti-toxin and hyperbaric oxygen chamber treatment is not preventive Value, on the contrary, the antibacterial drug prevention application has a positive effect, penicillin is the first choice, should be used as soon as possible after the injury should be separated from the patient, all the clothes used by the patient, dressings, equipment should be collected separately, disinfected, boiled and disinfected Should be more than 1h, preferably with high pressure steam sterilization, the replacement dressing should be destroyed to prevent cross-infection.
Complication
Complications of gas gangrene Complications
1. chills, fever: The initial symptoms of the patient are chills, fever, fine pulse and fatigue and fatigue.
2. Redness, pain or sensory disturbance: Infected local skin redness and swelling, unclear boundary between normalized tissue and surrounding normal tissue, local pain. If the sensory nerves in the skin are destroyed, it can also manifest as a sensory disturbance of the skin.
3. Ulcer formation: The lesion is gradually necrotic and dry, and the appearance looks like burnt anxiety. The infection does not involve deep tissues such as muscles and bones. Necrotic skin falls off after 2 to 3 weeks, forming an ulcer.
Symptom
Symptoms of gas gangrene common symptoms blood pressure drop irritability, high fever, cold sweat muscle necrosis, vocal expression, apathy, jaundice, dizziness
Local manifestation: The patient feels that the affected part is heavy and has a tight feeling of dressing. In the future, there is a sudden pain in the affected part. It can not be relieved with general analgesics, the affected part is swollen, the tenderness is severe, the skin around the wound is edema, nervous, pale, It glows brightly, turns purple-red, and turns into purple-black, and there are blisters of different sizes. The muscles in the wound are dark red or earthy gray due to necrosis, lose elasticity, and do not shrink or bleed when cutting. Like cooked meat, the sound around the wound is often pronounced, indicating that there is gas between the tissues, gently squeezing the affected part, often bubbles escape from the wound, and there is a thin, foul-smelling serous bloody secretion.
Systemic symptoms: Early patient expression is indifferent, dizziness, headache, nausea, vomiting, cold sweat, irritability, high fever, rapid pulse (100 ~ 120 times / min), respiratory urge and progressive anemia, severe poisoning symptoms in the late stage The blood pressure drops, and finally jaundice, convulsions and coma appear.
Examine
Examination of gas gangrene
Direct smear staining of exudate showed Gram-positive Bacillus megaterium, which was arranged alone or in pairs. At the same time, white blood cells were rarely deformed or broken, and could be rapidly identified by fluorescent antibody, enzyme-labeled antibody and enzyme-labeled SPA. It is worth noting that, from a bacteriological point of view, Cp is a Gram-positive bacillus, but the Cp detected from the infected site may be Gram-negative or positive after staining.
Diagnosis
Diagnosis and identification of gas gangrene
diagnosis
Diagnosis is mainly based on clinical manifestations, wound secretion examination and X-ray examination. For example, after injury or surgery, the wound has unusual pain, local swelling is rapidly increased, the skin around the wound is sputum, and there are serious symptoms of systemic poisoning such as pulse. Accelerated, irritated and progressive anemia, that is, the possibility of gas gangrene should be considered. The secretion smears in the wound are examined with a large number of Gram-positive bacilli, X-ray examination of the gas between the wound muscles, is the diagnosis of gas gangrene Three important reasons, anaerobic bacterial culture and pathological biopsy can confirm the diagnosis, but it takes a certain time, so you can not wait for the results, so as not to delay treatment.
Differential diagnosis
1. Bacillus cellulitis: The infection is confined to the subcutaneous cellulite, spreading rapidly along the fascia gap, but does not invade the muscle, generally slower onset, the incubation period is 3 to 5 days, although it begins with wound pain, around the wound There are also sputum sounds, but local pain and systemic symptoms are mild, skin is rarely discolored, and edema is very light.
2. Anaerobic streptococcal cellulitis: the onset is slow, often symptoms appear 3 days after injury, toxemia, pain, local swelling and skin changes are light, there are emphysema and sputum pronunciation, but gas The swelling is limited to the subcutaneous tissue and fascia, and there is general inflammatory performance around the wound. The exudate is serous and the smear is checked for streptococcus.
3. Escherichia coli cellulitis: interstitial emphysema may occur, and there are hyperthermia and sputum symptoms, but local swelling develops slowly. The pus has the characteristics of pus infected by E. coli, that is, the pus is thin. Serous, pus smear examination can be found Gram-negative bacilli.
