烧伤冻伤专题知识讲座.pptxVIP

烧伤冻伤专题知识讲座烧伤冻伤专题知识讲座第1页BurnColdInjuryAndBiteWacnd?Tissueinjurycausedbyheatiscalledburn(includingscald)?Burnincammenatordinarytimesorinwar.Atordinarytimes,scaldisthegreaterpartofburn.Ontheotherhand,burnofferhappensinwar.Accordingtodegreeofinjuryanddifferenceofbodyreaction,burncanbeclassifiedintothreestageinclinicalprocess.Atthesametime,thethreestageconnectswitheachotherandcould烧伤冻伤专题知识讲座第2页notbedistinguishedentirely.Ishockstage.Itishypovolemicshock,Ⅱ,infectivestage.Theinfectiveincidenceisthehignestintwoweekspostburn,Ⅲ,repairationstage.Woundbegintorepairsoonafterburnhapped.Inourcountrythetreatmentlevelofburncomesuptoadvancedworldstandards.MostVnitscuredmanypatientsofexceedingⅢ°SBA90%.Thetotalcurerateamounttoover95%,wemaintainthatpatientswithlargeburnareaanddeepdegreeburnshouldbecarriedoutremavalofescharandskin烧伤冻伤专题知识讲座第3页graftinginbatchesandbystages.Theresultwassatisfied.Keywords:burn,coldinjury,bitewound,scald,shock,repairationwound,eschar,skingrafting.?烧伤冻伤专题知识讲座第4页第一节热烧伤(LessonOneBurn)烧伤临床过程及病理生理特点（一）体液渗出期（休克期）[Acutehumoralexadativestage(shockstage)]（二）急性感染期(Infectiousstage)（三）创面修复期(Repairationstage)（四）康复期烧伤冻伤专题知识讲座第5页临床表现和诊疗（一）烧伤面积和烧伤深度预计1.面积预计(Estimateofburnarea)（1）中国新九分法（2）手掌法2.深度预计(Judgemetofburndepth)三度四分法（二）烧伤严重程度(Degreeofburn)烧伤冻伤专题知识讲座第6页新九分法部位占成人体表%占儿童体表%发部头颈{面部颈部33}939+(12_-年纪)双上肢双上臂双前臂双手76}9χ259χ2驱干躯干前躯干后回阴13139χ319χ3双下肢双臀双大腿双小腿双足5219Χ5+11379χ5+1-(12—年纪)烧伤冻伤专题知识讲座第7页烧伤程度深度病理临床表现愈合过程一度（红版）表皮浅层，生发层健在，再生能力强局部血管扩张充血渗出轻度红肿热痛，感觉过敏，表皮干燥无水泡，红斑状3—7日痊愈，短期色素从容，无瘢痕浅二度（水疱性）表皮生发层，真皮乳头层血浆渗出积于表皮和真皮之间剧痛，感觉过敏，大小不一水疱，水疱剥脱可见均匀发红、潮湿水肿显著1—2周，不留瘢痕，色素从容，多数无瘢痕深二度真皮有附件残留局部组织坏死，皮下层渗出显著痛觉迟钝，可有或无水疱，基底红白相间3—4周，瘢痕愈合三度（焦痂）达真皮全层，有时深达皮下组织，肌肉和骨骼皮肤坏死，蛋白凝固，形成焦痂皮肤痛觉消失，无弹性，干燥无水疱，皮革样，蜡白，焦黄或炭化，局部温度低，数日后出现树枝状血管2—4周后焦痂脱去形成肉牙创面，小则斑痕愈合