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潜江科普:伤口的处理
时间:2019-07-17 07:03:02   来源:    分享到:

  1)对现场处理伤口的认知
 
  外伤后常在体表形成伤口,有时合并血管、神经损伤,甚至骨折。严重外伤可合并颅脑、心肺、腹腔脏器损伤。
 
  体表形成伤口后外界细菌、异物进入伤口,可引起感染。有血管损伤时出血多,能导致休克。因此,现场伤口处理十分重要。
 
  现场处理好伤口,就能防止伤口进一步污染,在地震等灾害时,地面及浅层地表的大量细菌尤其平时很少见到的厌氧细菌侵入人体,如引起破伤风、气性坏疽等严重污染致命的疾病发生率很高,所以要十分重视伤口和及时清理,减少感染机会。防止出血过多,预防休克。
 
  要仔细检查伤口,注意伤口的位置、大小、污染程度,血管、神经、肌肉、肌腱损伤及骨折等情况,还要判断是否有颅脑及胸腹损伤,更重要的是注意有无休克。因此,要根据不同的伤口做不同的伤口处理。
 
  2)伤口处理
 
  一般伤口或称普通伤口,是指伤口较小,表浅,不伴血管神经损伤,但容易止血。
 
  现场有条件时,用生理盐水冲洗伤口(或用纯净水、瓶装饮用水等),然后,在伤口周围皮肤用75%酒精消毒(注意不要让酒精进入伤口),再用无菌敷料爆炸。如现场无条件,伤口可用洁净布料、毛巾、衣物等压迫伤口,速转送到医院进行清创、缝合术。
 
  3)头部伤口
 
  头皮血运丰富,当头部受伤时,出血较多,常伴有颅骨骨折和颅脑损伤。头部伤口要尽快用无菌敷料或洁净布料压迫止血,出血较多时用手按压约15分钟可达止血目的,用尼龙网套固定敷料,或三角巾头部包扎。
 
  4)手指伤口
 
  手指最常见的是刀割伤,以伤口较齐为特点。受伤后用创口贴直接包扎,能起导止血消炎作用。用创可贴不要环形缠绕,这样容易造成手指缺血。应螺旋形缠在手指上,这样不应享受止血运。创可贴也不要太紧,过紧压迫手指静脉反而不易止血。
 
  手指外伤常合并肌腱断裂。手指有伤口时都要到医院进一步检查和治疗,要肌注破伤风抗毒素预防伤风,同时进行清创缝合术。
 
  手指切割伤又是造成指端缺损、出血不易止住。要立即用无菌敷料压迫伤口,同时用手掐住手指两侧,能得到良好止血目的。然后到医院进行残端修整术。
 
  5)手指离断伤
 
  手指完全断裂或血运完全中断的手指均称为手指离断伤。手指离断后要立即掐住伤指两侧防止出血过多,然后包扎手指残端,注意不要用绳索、布条捆扎手指,以免加重手指损伤或造成手指缺血坏死,不利于下一步治疗。
 
  离断的手指要用洁净物品如手帕、毛巾等包好,外套塑料袋或装入小瓶中,迅速运送医院。可奖状有离断手指的塑料袋或小瓶放入装有冰块的容器中,无冰块可用冰棍代替。不要将离断手指直接放入水中,不要直接与冰块冰棍放置一起,这样会影响手指再植成活率。
 
  6)伴有大血管损伤的伤口
 
  严重创伤、刀砍伤等造成大血管断裂,出血多,易造成出血性休克。因此,有效地止血是争取抢救时间,挽救伤员生命的重要措施。
 
  伴有大血管损伤的伤口较深,出血多,伤口远端脉搏搏动消失,肢体远端苍白,发凉,伤口内可见血管断端喷血,肌肉断裂外露。
 
  有时判断是否有大血管损伤较困难。所以现场急救时遇有出血多的伤口先按大血管损伤处理,待转送医院后进一步检查治疗。现场急救应按前面所述止血法救治。
 
  7) 伴有内脏或骨外露的伤口
 
  腹部伤口较大,当见有内脏溢出时,在现场不要将其归还腹腔,以免引起腹腔严重感染等。开放性骨折禁用水冲,不涂药物,外露的断骨眼劲送回伤口内,避免污染和刺伤血管、神经。上述情况伤口,均要保持其清洁,用大块敷料覆盖伤口,将环形垫固定腹内脱出物,三角巾包扎;骨折要用夹板固定,三角巾包扎。
 
  8) 伴有异物插入伤口
 
  伤口内如有表浅易取出的异物,可酌情取出。若是深又不易取出的异物决不可取出,以免造成更大出血、将细菌带入伤口等。刺入体腔或血管附近的异物要保留原处,严禁拔去,以免损伤内脏、血管、神经等。应当保护伤口的清洁,将刺入的异物固定牢,然后用绷带、三角巾包扎后尽快送至医院。(市科技局)

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