手术后感染-课件

SurgicalInfection手术后感染1ppt课件ContentsSurgicalinfectionSuperficialpurulentinfectionSpecialinfectionsGeneralpurulentinfectionHandspurulentinfectionintroductionPrinciplesofantibioticsusing2ppt课件3

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Surgicalinfection

■Wound,Tumor,deformityandother

SurgicalinfectionWound,Tumor,Other3ppt课件Part1Introduction4ppt课件IntroductionInfection:TheinflammationcausedbypathogenicmicroorganismwhichinvadehumanbodySurgicalinfection:needexcised,incisedordrained;OccupiesanunvascularizedspaceintissueOccursinanoperatedsite

Forexample:appendicitis,empyema,gasgangrene['ɡæŋɡrin],abscesses5ppt课件Characteristics1.Mostcausedbymultiplemicroorganisms2.Mainsymptom：Localinflammation3.Mostrelatedwithinjuryorsurgery4.Alwaysresultinlocalsuppuration，necrosis，withscarleftanddysfunction5.Whenmedicationhasnoeffection，asurgicaltreatmentisneed6ppt课件Classifications（1）Accordingtopathogenicmicroorganism（2）Accordingtoprogressionofillness（3）AccordingtoPrecipitatingfactorofdisease:Opportunisticinfection、suprainfection双重感染、nosocomialinfection院内感染7ppt课件Pathogenicmicrobes１、Nonspecificinfection：（purulentorGeneralinfection）staphylococcalaureus(金葡，S.a)、betahemolyticstreptococcus、EscherichiaColi、Bacteriodesfragilis脆弱类杆菌、proteus（变形杆菌）、Pseudo-monasaeruginosa（P.A.铜绿假单胞菌）Furuncle['fjʊərʌŋk(ə)l]，carbuncle['kɑrbʌŋkl]，appendicitis，cholecystitis（胆囊炎），cellulitis，abscess，osteomyelitis（骨髓炎）……①Onemicrobemaycauseseveraldiseases,onediseasemaycausedbyseveralmicrobes②Hasthesamepathologicalchangesandclinicalsymptoms8ppt课件Pathogenicmicroorganism２、specificinfection：SomespecificinfectionbybacteriaorFungi：tuberculosis、tetanus、Clostridiumperfringens（C.p

产气荚膜梭菌）、candidaalbicans（C.a白念珠菌）、Crypto-coccusneoformans（新型隐球菌）①Hasspecificpathologicalchangesandclinicalsymptoms②Hasspecificpreventionmethods9ppt课件Accordingtoillnessprogression1、Acuteinfection：within3weeks，Progressfast，mostnonspecificinfection2、Subacuteinfection：3weeks<infection<2monthsbetweenacuteandchronicmayresultfromacuteinfection，orcausedbymicroorganismwithmildvirulenceandresistance，orhumanresistanceispoor3、Chronicinfection：morethan2monthsTB10ppt课件Pathogenesis（1）Pathogenesisofmicrobes1、abhesionmolecules、Capsule2、enzyme、exotoxin、endotoxin（2）Humanbodyfactors1、Localfactors：

Mucosaldefect；ductblock；流水不腐circulatorydisturbance；otherlesions2、closedspace：oxygen、phagocyte，antibody，T、B，NKcells3、immunitydecrease：

wastingdiseases、hormone、radiotherapy、themotherapy，malnutrition，hypoproteinemia11ppt课件Localsymptoms1.Redness：bloodcongestion2.Swelling：effusionaccumulateintheinterstitialspace3.Hot：bloodhyperemia，metabolismincreases4.Pain：interstitialpressureincrease，inflammatorymediatorrelease（serotonin，bradykinin）stimulithenerveending5.Dysfunction：swelling，pain，tissuedestroy12ppt课件GeneralsymptomsMild：noobvioussymptomsSerious：toxemia：fever、generalmalaise、weak、inappetence、nausea、vomiting、Pulsefast，interstinalperistalsisdecrease，whitebloodcellincrease（leukocyte）Moreserious：metabolicdisturbance：fluidandelectrolyteunbalance,，oliguria,plasmaprotein（albumin）decreaseExtremelyserious：Septicemia，septicopyemia，liverandkidneysdysfunction，septicshock13ppt课件Examinations(1)clinicalexamination

1、generalcondition：vitalsigns、nutrition、shock

2、symptoms：

3、LocalSigns：red、swelling、hot、pain

4、specificsymptoms：tetanus—musclespasm；gasgangrene—crepitus捻发音

5、illnesshistory(2)assistantexamination：Lab（WBC白细胞计数）、radiology……14ppt课件Treatments(1)localprocessing1、avoiddiffusion2、superficial：wetcompress、physicaltherapy、incise、excise、drainage3、deeppart：surgicalresection(2)antibiotics：accordingtothemicrobes（drugsensitivetest,germiculture）15ppt课件Treatments(3)Systemicsupporttreatment1、restandsleeping2、fliudandelectrolytebalance，nultrition3、bloodcomponentstransfusion4、preventcomplications5、severepatients：corticalhormone16ppt课件Results（1）nonspecific

1、Inflammationbeingcontrolled

2、localfestering/purulent/abscess

3、inflammationexpand

4、chronicinflammation（2）specific

1、TB：specificgranuloma、

干酪的caseousnecrosis、coldabscess

2、tetanus、gasgangrene：acute，musclespasm；swellingandgas

3、fungus：

granuloma、ulcer、abscess、cavity17ppt课件Prevention（1）preventmicrobespollution1、sanitarycontrol；2、strictsterilization；3、steriletechnique；4、woundsdisposing（2）promotetheimmunityofhumanbody1、Specificimmune：TAT（tetanusantitoxin）2、Treatprotopathy3、Improvenutritionstatus18ppt课件Part2Superficialpurulentinfection19ppt课件Furuncle['fjʊərʌŋk(ə)l]疖Acutepurulentinfectionofsimplehairfollicle

andaroundtissue：mostcausedbyS.a（staphylococcalaureus）symptoms：Pimpleontheskin，2cm,red,swelling,hotandpain,脓疱pustuleonthecenter，

break，pusembolusgetoutandunion；ifnopustule，unionwillbedelayed20ppt课件Furuncle21ppt课件22ppt课件无头疖nopustule23ppt课件Furuncle['fjʊərʌŋk(ə)l]疖Diagnosis：easyDifferentialDiagnosis：1.acnewithinfection：fatonthetip，farfollice2.sebaceous皮脂的cystwithinfection：sebaceousglandductobstruction，epidermisnormal，smelly3.carbuncle：bigrange，mutiplehairfollicle24ppt课件FurunclePrevention：keepskincleanTreatments：1.initialstage：physicaltherapy，overcoating2.purulent：pickoutpusembolus3.

antibiotics：Penicillinantibiotics，Bactrobanointment百多邦软膏Attention：furuncleontheface（Dangeroustriangle）,preventsqueezing25ppt课件CarbuncleAcutepurulentinfectionofmultipleneighbouringhairfollicle

andaroundtissue：mostcausedbyS.a（staphylococcalaureus）symptoms：Middleageorold，red,swelling,hotandpain,multiplepustules，necrosisonthecenter；neckandback26ppt课件27ppt课件28ppt课件prevention：samewithfuruncleTreatments：

1.

antibioticsintime：intravenous,preventsepsisErythrocin（红霉素）、penbritin（氨卞青霉素）， Cephalosporinantibiotics（头孢）

2.localprocessing：A.

overcoating(ichthymall，magnesiumsulfate)；

B.ifpurulent：incisionin“十”shapeTreatments29ppt课件AcutecellulitisAcuteinfectionoflooseconnectivetissue,happeninallpartsofhumanbody：betahemolyticstreptococcus、S.a、E.cSymptoms：acute，diffusibility，purulentSubcutaneousSubfascialintermuscularspaceDeepconnectivetissue30ppt课件AcutecellulitisCharcteristicsAnypartsofhumanbodySpreadquickly，hardtolimitNoobviousboundarylinebetweennidusandnormaltissueGeneralsymptomsareobvious31ppt课件AcutecellulitisLocalSymptoms：inflammationsymptoms，noobviousboundarylineCenter：rederthanedge，blanchonpressureSuperficial：severeswellingbutmildpainDeep：mildswellingbutseverepainNeighbourlymphanode：largeGeneralsymptomsChill，Fever，headache，weak，generalmalaiseSign：red，edema，pain，crepitus捻发音32ppt课件Acutecellulitis33ppt课件TreatmentsAntibiotics：Cephalosporins，Penicillin，metronidazole（anaerobics）magnesiumsulfate（50%）

wetdressingIncisionanddrainagePreventcomplications34ppt课件ErysipelasAcuteinflammationofLymphocapillarynetworkinvadedbybetahemolyticstreptococcus

。Therearealwaysskininjurybefore,suchasulcerSymptoms：Fever，chill，generalmalaise，weakLowerlimb，face；Signs：Skininflammation、apophysis（微隆）、obviousboundaryline、largelymphglandbrightred，colordegradewithfingerpress，recoverwithfingerremoved35ppt课件Erysipelas36ppt课件ErysipelasCruserysipelasRelatedwithFilariasis（parasite）elephantedema37ppt课件erysipelasFilariasis丝虫

…LymphoductobstructionLymphodepositelephantedemaErysipelas38ppt课件Acutelymphadenitis

AcutelymphangitisMicrobesinvadelymphasystemStreptococcus，S.aAllpartsSymptoms：Acutelymphadenitis：Largelymphanode、painlump、severepain，skinredandhotabscessAcutelymphangitis：ExtremitiesSuperficial：skinredlineDeep：paininalineshape39ppt课件Acutelymphangitis40ppt课件TreatmentsLieinbedWithinfectedlimbupPhysicaltherapyAntibiotics41ppt课件Abscess42ppt课件Abscess（1）Definition：AcutepurulentinfectionTissuenecrosisLiquidcollectionIfimpededdrainage：nonunionS.A(2)

Symptoms：①superficial：red，swelling，hot，pain，fluctuation②deep：pain，pressingpainparacentesisUltrasonicGeneralsymptoms43ppt课件Treatments：1．Incisionanddrainage：a:goodlooking

b:suitablesizec:

goodfordrainaged:

avoidtoinjurenerveandvessel2.Drainageinincision：a：amount，color，changementb：changedressinguntilunion3.Generaltreatments：Largedoseofantibiotics4.Coldabscess：donotinciseoptionally，hardtounion，treatTB44ppt课件Part3Acutepurulentinfectionofhands45ppt课件Paronychia[,pærə'nikiə]andfelonParonychia：purulentinfectionofsofttissuearoundnailOnesidenailgroove，red，swelling，painfluctuationanotherside，severepaindumbbellabscessfelon46ppt课件Paronychiaandfelon47ppt课件TreatmentsNoabscess：nosurgical，Ichthammol鱼石脂，physicaltherapy48ppt课件Part4Generalpurulentinfection49ppt课件DefinitionsGeneralpurulentinfection：Pathogenicbacteriaistremendous，virulenceisstrong，humanbodycannoteliminatethem，whichreproducedinbloodBacteremia：Smallamountbacteriainblood,withmildvirulence.StrongImmunityEliminatethebacteriaquickly,nogeneralreaction50ppt课件DefinitionsToxaemia：Thetoxinofbacteriaorthemateriaoftissuenecrosiongetintoblood,notthebacteria,severegeneralreaction.Symptoms:Fever,sweat,thinPulse,shockSepticemia/Sepsis：Thebacteriagetintoblood,reproduceandgeneratetoxins,acutegeneralinfection.Symptoms:Fever,sweat,thinPulse,shock51ppt课件Common

pathogenicbacterias1、Gram-negativebacteria:EscherichiaColi(大肠杆菌)、bacteroid拟杆菌、Pseudomonasaeruginosa(绿脓杆菌)、proteus(变形杆菌)、Klebsiellapneumoniae(克雷伯菌)、Enterobacter(肠杆菌)。abdominalcavity、intestinaltract、urinarysystem2、Gram-positivebacteria:S.a、staphylococcusepidermidis(S.e)、enterococcuscoccus3、anaerobicbacteria:abdominalabscess、appendicularabscess4、fungus:Candidaalbicans，opportunisticinfection52ppt课件SymptomsMain:Fever,sweat,thinPulse,shock,dizzy,volmiting,delirium,Heartratefast,rapidaspirationLabexams:Whitebloodcell,acidosis,hemolysis,germiculturepositive53ppt课件Clinicalsymptoms1、Gram-positivebacteria:Carbuncle,cellulitisHighfever,Redface,limbwarm,，delirium/coma，metastaticabscess2、Gram-negativebacteria:Bileduct、urinarytract、intestinaltract、burnwoundschill，non-obviousfever，coldlimb、cyanosis、shockearlyandlong3、Fungus:Suprainfection，chillandfeversuddenly(39.5~40)，worsenquickly、shock、bloodtest54ppt课件DiagnosisandtreatmentsDiagnosis：Primaryinfectionfocal＋symptoms＋Labexams（germiculture）Treatments：EliminatePrimaryinfectionfocal，deadspace，abscessdrainageAntibiotics：early+fulldose+combinationSupportingTherapy，bloodvolume，nultritionsymptomatictherapy55ppt课件Part5Specialinfections56ppt课件TetanusClostridium[klɒ'strɪdɪəm]tetani：anaerobicbacteria→exotoxin-sphacelotoxinandhematoxin（痉挛毒素、溶血毒素）Symptoms：latentstage6-12days，paroxysmalspasm：sardonic[sɑː'dɒnɪk]facies（苦笑）

opisthotonos[,ɔpis'θɔtənəs（角弓反张）Causedbylightandwater,normalconsciousness57ppt课件sardonic

[sɑː'dɒnɪk]facies

58ppt课件Opisthotonos

[,ɔpis'θɔtənəs]角弓反张59ppt课件DiagnoseAccordingtosymptomsDifferentialdiagnosispurulentmeningitis：nospasm，severeheadache、fever、projectilevomiting、

CerebrospinalFluidCSF、wholebloodtestHydrophobia（狂犬病）：animalbite60ppt课件TreatmentsWoundsdisposingAntitoxin：neutralizationexotoxinAvoildlight，sound：sedativedrug，SpasmolysisdrugComplicationprevention：asphyxia[əs'fɪksɪə]、lunginfection，bonefracture，mayneedtracheotomy，assistedrespirationSupportingTherapy：protein，energy，vitamin，fluidandelectrolyte61ppt课件GasgangreneThecause：Spindle-shapedbacillus,oftenmixinfectionsmusclenecrosismyositisprogressfasterandhaveapoorprognosis.Pathologicalphysiology：produceexotoxinandenzymegasproducing、edemapressureincreasingunderfasciathecompressionofmicrovasculartissuehypoxia-ischemianecrosis62ppt课件1-4daysafterinjury,theconditiondeterioratedsuddenly:Irritability,pale,increasingofpulserate,feverComplaints:Theinjuredlimbisheavyandcontinuedincrease;severepain,lotsifexudation，woundbubbles,odor,finecrackles，theskinseemsmarblingAiraccumulatio