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病例男,42岁,火焰烧伤后5h 入院,查烧伤面积55％,Ⅲ度32％,伴中度吸入性损伤及休克,行气管切开,液体复苏,静脉应用头孢三嗪等治疗。入院6h 内曾呕血约*****600ml。伤后第6天上午背部、两上肢创面出现较多散在出血点,主诉视物不清。检查:视力仅指数,两眼视物一致性变大,下午体温39.6“C。次日上午完全失明。眼科检查:意识清楚,强光刺激及手势威胁无瞬目反应,瞳孔对光反射灵敏,眼底正常。背部、两上肢创面出血点较前明显增加,实验室检查:WBC 20.6×109/L,中性粒细胞O.906。创面培养为阴沟肠杆菌、大肠埃希氏菌,行4次血培养均阴性。给予吸氧,并将抗生素改为泰能静脉滴注,10％磺胺米隆软膏纱布包扎创面。中午高热,烦躁,定向力丧失。第2天意识清醒。伤后第12天创面感染控制,体温38～39*(2,视力部分恢复,两眼复视。次日行两上肢削痂植皮术,面积15％,术日及术后第1天体温分别达39.6’12、39.5℃。术后第2天低热,视力完全恢复。
Male, 42 years old, was admitted to the hospital at 5 hours after the burn of the flames. The burns area was 55%, degree Ⅲ was 32%, with moderate aspiration injury and shock, tracheotomy, fluid resuscitation and intravenous ceftriaxone treatment. Within 6h admitted hematemesis about ***** 600ml. On the 6th day after injury, there were more scattered blood spots in the back of the wounds on the morning of the 6th day. The main complaint was unclear. Check: visual acuity index only, both eyes visual consistency becomes larger, the afternoon temperature 39.6 ”C. The next morning completely blind .Ophthalmology examination: Consciousness, strong light stimulation and no threat of blinking gesture reaction, the pupil sensitive to light reflection , The fundus of the eye was normal.The back and upper extremity wound bleeding point was significantly increased compared with the previous, laboratory tests: WBC 20.6 × 109 / L, neutrophil O.906. Wound culture for Enterobacter cloacae, Escherichia coli, line 4 Blood cultures were negative. Give oxygen, and antibiotics to Thai intravenous infusion, 10% sulfamelting ointment gauze bandage wound. Noon fever, irritability, loss of orientation .2 days conscious wake .12 Day wound infection control, body temperature 38 ~ 39 * (2, partial visual acuity recovery, eyes double dip. The next day the two upper limbs crust abscess skin graft, an area of 15%, on the 1st day and postoperative day body temperature reached 39.6’12 , 39.5 ℃ .The second day after the fever, visual acuity completely restored.