最全十大名校外科学17.ppt

烧伤、冷伤 Burns Cold injury Lesson Four Bit Wound 哈尔滨医科大学第一临床医学院 烧伤整形科 翟舒娅 Burn Cold Injury And Bite Wacnd ? Tissue injury caused by heat is called burn ( including scald ) ? Burn in cammen at ordinary times or in war. At ordinary times, scald is the greater part of burn. On the other hand, burn offer happens in war. According to degree of injury and difference of body reaction, burn can be classified into three stage in clinical process. At the same time, the three stage connects with each other and could not be distinguished entirely. I shockstage. It is hypovolemic shock, Ⅱ, infective stage. The infective incidence is the hignest in two weeks post burn, Ⅲ, repairation stage. Wound begin to repair soon after burn happed. In our country the treatment level of burn comes up to advanced world standards. Most Vnits cured many patients of exceeding Ⅲ° SBA 90%. The total cure rate amount to over 95%, we maintain that patients with large burn area and deep degree burn should be carried out remaval of eschar and skin grafting in batches and by stages. The result was satisfied. Key words: burn, cold injury, bite wound, scald, shock, repairation wound, eschar, skin grafting. ? 第一节 热烧伤 (Lesson One Burn) 烧伤的临床过程及病理生理特点 （一）体液渗出期（休克期） [Acute humoral exadative stage (shock stage)] （二）急性感染期(Infectious stage) （三）创面修复期(Repairation stage) （四）康复期 临床表现和诊断 （一）烧伤面积和烧伤深度估计 1.面积的估计(Estimate of burn area) （1）中国新九分法 （2）手掌法 2.深度的估计(Judgemet of burn depth) 三度四分法 （二）烧伤严重程度(Degree of burn) 新九分法 三度四分法 一度和浅二度烧伤 深二度烧伤 三度烧伤（1） 三度烧伤（2） 现场急救 (Emergency treatment, transportation and primary treatment.) （一）灭火 （二）灭火后的处理 烧伤的早期处理 （一）轻度烧伤的早期处理 1.一般处理 2.创面初期处理 3.包扎疗法 4.显露疗法 （二）中、重度烧伤的早期处理 1.处理程序 2.烧伤休克的防治 ⑴补液治疗 ①补液公式： 伤后第一个24小时补液量： 成人每1%烧伤面积（Ⅱ、Ⅲ°）×0.5ml 胶体 ×1ml电解质 另加水分2000ml ②液体的选择 ③延迟复苏病人的补液治疗 ⑵保持呼吸道通畅 ⑶镇静止痛 ⑷其他药物治疗 烧伤创面的处理 (Management of wound) （一）浅度创面的处理 （二）深度烧伤创面的处理 1.切痂植皮 2.削痂植皮 3.蚕食脱痂 （三）植皮术 1.大张中厚自体