医学课件 感染--【汉魅HanMei—医学专区分享】演稿.ppt

Surgical Infection Teng Changsheng Dept. of general surgery Beijing Friendship Hospital Affiliated to Capital University of Medical Sciences Classification of Surgery Infection Diagnosis (1)?? Endemic treatment Systemic treatment Treatment Surgical treatment requires debridement of all necrotic tissue. All necrotic tissue must be removed. Amputation may be required for myonecrosis of the extremities. The wound must be inspected daily until the surgeon can be sure there is no further necrosis. Initially, broad-spectrum antibiotics should be administered. Hyperbaric Oxygen Treatment The use of hyperbaric oxygen to treat necrotizing soft tissue infections is controversial. Hyperbaric oxygen inhibits production of alpha toxin by clostridium. Tetanus Tetanus is caused by C. tetani, a large gram-positive sporeforming bacillus. It is acquired by implantation of the organisms into tissues by means of breaks in the mucosal or skin barriers. Action of C. tetani C. tetani elaborates : tetanospasmin tetanolysin. Tetanospasmin acts on the anterior horn cells of the spinal cord and on the brainstem. It blocks inhibitor synapses at these sites, leading to muscle spasms and hyperreflexia. Tetanolysin is cardiotoxic and causes hemolysis Manifestation of Tetanus Symptoms: restlessness, headache, muscle spasms with vague discomfort in the neck, lumbar region, and jaws,swallowing difficult, stiff neck Progressively,Orthotonos, opisthotonos, and emprosthotonos ,Generalized toxic convulsions. These convulsions may involve the laryngeal and respiratory muscles and result in fatal acute asphyxia. Other symptom:Throughout these spasms, which can be extremely painful and even cause fractures, the patient remains mentally alert. The pulse is elevated and there is profuse perspiration. Fever may or may not be present. Diagnosis Diagnosis of tetanus is based on the clinical picture associated with no prior history of immunization.The differentia