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冻疮的治疗
原作者: Michael Bond, 肖锋译 发布日期:2014-01-09

Title: FrostBite Treatment
题目:冻疮的治疗
Author 作者: Michael Bond


"Frozen in January, Amputate in June"  - By Kinjal Sethuraman and Doug Sward
 “一月份冻疮, 六月份截肢” – 根据Kinjal Sethuraman和Doug Sward医生

Frostbite can lead to major tissue damage even if initial presentation does not look so severe. Treatment is NOT the same as for burns. 
冻疮可能导致严重的组织损伤,即使初期表现看起来不那么严重。治疗方法与烧伤不一样。

Treatment of Major Frostbite:
严重冻疮的治疗方法:
1.  Rapid rewarming ASAP of affected area in 40 Celsius degree water until area is thawed (pink and pliable). Logistics are difficult because you have to maintain a constant water temperature- but only if you can maintain same degree of warmth.  Rewarming and refreezing will lead to inevitable tissue death.
1 。尽快将患处浸入摄氏40度的热水中快速复温,直到部位被解冻(粉红色和柔软)。只有在你能保持恒定温度的水时,一定要保持水温。复温和再冻结将导致不可避免的组织死亡。
2. Wound care, Aloe Vera, ASA 
2 。伤口护理,芦荟,阿司匹林
3.  DELAY surgery except in cases of sepsis or compartment syndrome.
3 。除非有脓血症或骨筋膜室综合征,否则可以延迟手术。
 
CUTTING EDGE:
新进展 :

If less than 24 hours since injury, consider diagnostic angiography and  intra-arterial TPA, and heparin infusion, Prostacyclin infusion.
如果冻疮后不到24小时,可考虑诊断性动脉造影及动脉内TPA,滴注肝素,静脉滴注前列环素。
Angiography and Bone Scan can be used to prognosticate clinical course.
血管造影和骨扫描可以用来判断临床过程。
Consider Hyperbaric Oxygen Therapy for moderate to severe frostbite- multiple case reports of significant improvement with HBOT even if delayed by several days. 
对中度到严重的冻疮,可考虑高压氧治疗——有多个病例报告,即使延迟几天,高压氧治疗效果还是显著的。
 
Treatment of Minor Frostbite:
轻微冻疮的治疗:
1. Rewarm area
1 。局部复温
2. Ibuprofen
2 。布洛芬
3. Aloe Vera and dressing changes
3 。芦荟和换药
 
Reference 参考文献:
Frostbite http://www.ncbi.nlm.nih.gov/pubmed/21664561