化学性皮肤灼伤的治疗--杨远锋的博客

化学性皮肤灼伤的治疗　

[ 2011-4-18 20:23:00 | By: 杨远锋 ]

l．迅速移离现场，脱去污染的衣着，立即用大量流动清水冲洗20~30分钟。碱性物质污染后冲洗时间应延长，特别注意眼及其它特殊部位如头面、手、会阴的冲洗，灼伤创面经水冲洗后，必要时进行合理的中和治疗，例如氢氟酸灼伤，经水冲洗后，需及时用钙、镁的制剂局部中和及治疗，必要时用葡萄糖酸钙动、静脉注射。
2．化学灼伤创面应彻底清创、剪去水疱、清除坏死组织。深度创面应立即或早期进行削（切）植皮及延迟植皮。例如黄磷灼伤后应及早切痴，防止磷吸收中毒。
3．对有些化学物灼伤，如氰化物、酚类、氯化钡、氢氟酸等在冲洗时应进行适当解毒急救处理。
4．化学灼伤合并休克时，冲洗从速、从简，积极进行抗休克治疗。
5．积极防治感染、合理使用抗生素
（1）清创后，创面外搽1%磺胺嘧啶银霜剂（磺胺过敏者忌用）。
（2）伤后3天内选用青霉素，预防乙型链球菌感染。
（3）大面积深度灼伤、休克期病情不平稳或曾经长途转运或合并爆炸伤或创面严重感染、不易干燥、有出血点、创缘明显炎性浸润，伤后第二天即应调整抗生素，选择主要针对革兰氏阴性杆菌的抗生素如氨苄、氧哌嗪青霉素或第二、三代头孢菌素（头孢哌酮），必要时联合应用一种氨基贰类抗生素（链霉素、庆大霉素或丁胺卡那霉素等），并兼用抗阳性球菌的抗生素。若有继续使用抗生素的指征，根据药敏重新调整抗生素。
（4）植皮手术前创面培养分离到乙型溶血性链球菌，必须术前和术后全身应用大剂量青霉素。青霉素过敏者选用红霉素。
（5）灼伤后期引起败血症的病原菌主要是金葡菌，故应选择对金葡菌敏感的抗生素，但大多数对青霉素耐药，常用耐青霉素酶的青霉素如苯唑青霉素（P12）或头孢菌素（第一代如头孢氨节、头泡唑啉、头孢噻吩），但仍不能忽视革兰氏阴性杆菌感染的可能性。
（6）关于重症感染中抗生素的应用，一般原则为一种β-内酰胺类抗生素（包括青霉素类和头孢菌素类）加一种氨基糖贰类（包括链霉素、庆大霉素、丁胺卡那霉素等）较为合适，具体用药方案应取决于致病菌种类和药敏试验。

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原创

[ 2016-9-6 20:29:45 | By: 原创(游客) ]

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原创

[ 2016-9-28 20:07:20 | By: 原创(游客) ]

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原创

[ 2016-9-30 14:47:37 | By: 原创(游客) ]

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Re:在漫画中识别身边的违章

[ 2016-10-8 15:06:50 | By: nlaei(游客) ]

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Re:在漫画中识别身边的违章

[ 2016-10-8 15:37:26 | By: wvknr(游客) ]

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Re:在漫画中识别身边的违章

[ 2016-10-11 14:02:20 | By: gfvxb(游客) ]

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Re:在漫画中识别身边的违章

[ 2016-10-13 15:31:49 | By: ujnru(游客) ]

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Re:在漫画中识别身边的违章

[ 2016-10-16 5:12:06 | By: shjnr(游客) ]

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Re:在漫画中识别身边的违章

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Re:在漫画中识别身边的违章

[ 2016-10-21 13:53:37 | By: jiyav(游客) ]

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