目的探讨早期伤口分泌物涂片检查对创伤性气性坏疽早期诊断的作用。方法回顾性分析2003年4月至2006年4月本院收治的受伤后超过1 h的10 881例开放性创伤患者的资料,对其伤口分泌物早期常规作革兰染色涂片检查。结果本组创伤患者发生气性坏疽11例,发病率为0．10%。其中车祸伤5例,机器压伤3例,石头压伤2例,枪伤1例。受伤部位在上肢7例(63．6%),下肢3例(27．3%),下颌部合并头颈部伤1例(9．09%)。发病时间(3．3±2．2)d,均全部治愈。7例合并粉碎性骨折、已丧失肢体功能的患者均行伤肢截肢,3例肢体创伤没有骨折的患者及1例下颌部合并头颈部伤气性坏疽立即行外科清创、联合选用抗菌谱广(包括革兰染色阳性和阴性)的头胞菌素和高压氧治疗后均治愈。结论气性坏疽发生率少但比较致命,医生诊断时应提高警惕。清洗和清创术对预防感染是关键,高压氧是一种有益的辅助治疗。早期伤口分泌物涂片查找革兰染色粗大杆菌对早期诊断创伤性气性坏疽有一定的作用,且快速简便。 Objective To investigate the effect of early wound smear examination on the early diagnosis of traumatic gas gangrene. Methods The data of 10 881 patients with open trauma who were admitted to our hospital from April 2003 to April 2006 after being injured for more than 1 h were retrospectively analyzed. The wound secretions were routinely examined with gram-positive smear. Results In this group of traumatic patients, 11 cases of gas gangrene occurred, the incidence was 0.10%. Including car accident in 5 cases, machine crush in 3 cases, stone crush in 2 cases, gunshot wound in 1 case. There were 7 cases (63.6%) in the upper limbs, 3 cases (27.3%) in the lower limbs, and 1 case (9.09%) in the lower jaw. The onset time (3.3 ± 2.2) d, all were cured. Seven patients with comminuted fractures and limbs had limb amputation, three patients with limb trauma without fractures, and one patient with head and neck genital gangrene in the mandibular region immediately underwent surgical debridement combined with antimicrobial spectrum Wide (including Gram-positive and negative Gram-positive cephalosporin and hyperbaric oxygen were cured after treatment. Conclusions The incidence of gas gangrene is small but relatively fatal, and doctors should be alert when diagnosed. Cleaning and debridement are key to preventing infection and hyperbaric oxygen is a helpful adjunctive therapy. Early wound smear smear Gram stain crude bacilli early diagnosis of traumatic gas gangrene have a certain role, and quick and easy.