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手部感染概述

Authors
Sandeep Sebastin, MMed, FAMS
Kevin C Chung, MD, MS
Shimpei Ono, MD, PhD
Section Editor
Charles E Butler, MD, FACS
Deputy Editor
Rosemary B Duda, MD, MPH, FACS

引言

上肢感染性疾病很常见，占手外科住院患者的比例高达35%。大多数急性手部感染患者为健康的、活跃的年轻成人，他们往往忽略或延误对轻微创伤进行恰当的治疗[1]。较严重感染见于免疫状态受损的患者。

非手术治疗可能对早期和浅表手部感染有效，但大多数手部感染需要急诊手术治疗。手部感染如果能及时地诊断和评估病情，并进行正确的治疗，可以取得良好的预后，否则可能导致终身残疾。

初步评估和处理

手部感染的初步评估和处理包括重点病史采集和体格检查，通常还包括实验室评估和影像学检查。应标记红斑区域以帮助记录感染的进展情况。抬高手和手臂、使用保暖袋热敷及适当止痛，会减轻肿胀并使患者感到舒适。同时应该开始应用抗生素经验性抗感染治疗。这些措施讨论如下。

病史 — 重点突出的病史应确定可能的感染源、感染进程、患者的免疫状态及任何相关的既往病史：

●症状─记录疼痛发作、功能损失、发热和/或寒颤及任何自发流液。严重搏动痛提示在密闭的间隙里有脓肿形成。全身情况迅速恶化提示有严重感染，如坏死性筋膜炎和气性坏疽。 (参见下文‘坏死性筋膜炎’和“坏死性软组织感染”)

                                    

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-26.
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