手术后感染-课件.ppt

1、Surgical Infection手术后感染1ppt课件Contents SurgicalinfectionSuperficial purulent infectionSpecial infectionsGeneral purulent infectionHands purulent infectionintroductionPrinciples of antibiotics using2ppt课件3 Surgical infection Wound,Tumor,deformity and other Surgical infectionWound,Tumor,Other3ppt课件Part

2、 1Introduction4ppt课件Introduction Infection:The inflammation caused by The inflammation caused by pathogenic microorganism pathogenic microorganism which invade human bodywhich invade human bodySurgical infection:need need exexcised,cised,inincised or drained;cised or drained;Occupies an unvasculariz

3、ed space in tissueOccupies an unvascularized space in tissueOccurs in an operated siteOccurs in an operated site For example:appendicitis,empyema,gas gangrene appendicitis,empyema,gas gangrene rin,abscessesabscesses5ppt课件Characteristics1.Most caused by multiple microorganisms2.Main symptom：Local inf

4、lammation3.Most related with injury or surgery4.Always result in local suppuration，necrosis，with scar left and dysfunction5.When medication has no effection，a surgical treatment is need6ppt课件Classifications（1）According to pathogenic microorganism（2）According to progression of illness（3）According to

5、Precipitating factor of disease:Opportunistic infection、suprainfection双重感染、nosocomial infection院内感染7ppt课件Pathogenic microbes、Nonspecific infection：（purulent or General infection）staphylococcal aureus(staphylococcal aureus(金葡，金葡，S.a)S.a)、beta hemolytic streptococcus beta hemolytic streptococcus、Esche

6、richia Escherichia Coli Coli、Bacteriodes fragilis Bacteriodes fragilis 脆弱类杆菌、脆弱类杆菌、proteus proteus（变形杆菌）、（变形杆菌）、Pseudo-monas Pseudo-monas aeruginosaaeruginosa（P.A.P.A.铜绿假单胞菌）铜绿假单胞菌）FuruncleFuruncle fjrk()l，carbuncle carbuncle krbkl，appendicitis appendicitis，cholecystitis cholecystitis（胆囊炎），（胆囊炎），cel

7、lulitis cellulitis，abscessabscess，osteomyelitis osteomyelitis（骨髓炎）（骨髓炎）One microbe may cause several diseases,one disease may caused by several microbes Has the same pathological changes and clinical symptoms8ppt课件Pathogenic microorganism、specific infection：Some specific infection by bacteria or Fun

8、gi：tuberculosis、tetanus、Clostridium perfringens（C.p 产气荚膜梭菌）、candida albicans（C.a白念珠菌）、Crypto-coccus neoformans（新型隐球菌）Has specific pathological changes and clinical symptoms Has specific prevention methods9ppt课件According to illness progression1、Acute infection：within 3 weeks，Progress fastProgress fas

9、t，most nonspecific infectionmost nonspecific infection2、Subacute infection：3 weeksinfection 2 months between acute and chronicbetween acute and chronic may result from acute infectionmay result from acute infection，or caused by microorganism with mild or caused by microorganism with mild virulence a

10、nd resistancevirulence and resistance，or human resistance is poor or human resistance is poor 3、Chronic infection：more than 2 months TBTB10ppt课件Pathogenesis （1）Pathogenesis of microbes1、abhesion molecules、Capsule2、enzyme、exotoxin、endotoxin （2）Human body factors1、Local factors：Mucosal defect；duct blo

11、ck；流水不腐；流水不腐 circulatory disturbance；other lesions2、closed space：oxygen、phagocyte，antibody，T、B，NKcells3、immunity decrease：wasting diseases、hormone、radiotherapy、themotherapy，malnutrition，hypoproteinemia11ppt课件Local symptoms1.Redness：blood congestion2.Swelling：effusion accumulate in the interstitial s

12、pace3.Hot：blood hyperemia blood hyperemia，metabolism increasesmetabolism increases4.Pain：interstitial pressure increase，inflammatory mediator release（serotonin，bradykinin）stimuli the nerve ending5.Dysfunction：swelling，pain，tissue destroy12ppt课件General symptoms Mild：no obvious symptomsSerious：toxemia

13、toxemia：feverfever、general malaise、weakweak、inappetenceinappetence、nauseanausea、vomitingvomiting、Pulse fast，interstinal peristalsis interstinal peristalsis decreasedecrease，white blood cell increasewhite blood cell increase（leukocyte leukocyte）More serious：metabolic disturbancemetabolic disturbance：

14、fluid and electrolyte unbalance,，oliguria,plasma protein（albumin）decreaseExtremely serious：SepticemiaSepticemia，septicopyemiasepticopyemia，liver and kidneys liver and kidneys dysfunctiondysfunction，septic shockseptic shock13ppt课件Examinations(1)clinical examination 1、general condition：vital signs、nut

15、rition、shock 2、symptoms：3、Local Signs：red、swelling、hot、pain 4、specific symptoms：tetanus muscle spasm；gas gangrene crepitus 捻发音 5、illness history(2)assistant examination：Lab（WBC 白细胞计数）、radiology14ppt课件Treatments(1)local processing1、avoid diffusion2、superficial：wet compress、physical therapy、incise、exc

16、ise、drainage3、deep part：surgical resection(2)antibiotics：according to the microbesaccording to the microbes（drug sensitive drug sensitive test,germiculturetest,germiculture）15ppt课件Treatments(3)Systemic support treatment 1、rest and sleeping 2、fliud and electrolyte balance，nultrition 3、blood component

17、s transfusion 4、prevent complications 5、severe patients：cortical hormone16ppt课件Results（1）nonspecific1 1、Inflammation being controlledInflammation being controlled2 2、local festering/purulent/abscesslocal festering/purulent/abscess3 3、inflammation expandinflammation expand4 4、chronic inflammationchro

18、nic inflammation（2）specific1、TB：specific granuloma、干酪的干酪的caseous necrosis、cold abscess2、tetanus、gas gangrene：acute，muscle spasm；swelling and gas 3、fungus：granuloma、ulcer、abscess、cavity17ppt课件Prevention（1）prevent microbes pollution1、sanitary control；2、strict sterilization；3、sterile technique；4、wounds

19、 disposing（2）promote the immunity of human body1、Specific immune：TAT（tetanus antitoxin）2、Treat protopathy3、Improve nutrition status18ppt课件Part 2Superficial purulent infection19ppt课件Furuncle fjrk()l 疖Acute purulent infection of simple hair follicle and around tissue：most caused by S.amost caused by S

20、.a（staphylococcal aureusstaphylococcal aureus）symptoms：Pimple on the skinPimple on the skin，2cm,red,swelling,hot 2cm,red,swelling,hot and pain,and pain,脓疱脓疱pustule on the centerpustule on the center，breakbreak，pus embolus get out and union and union；if no pustuleif no pustule，union will be delayedun

21、ion will be delayed20ppt课件Furuncle 21ppt课件22ppt课件无头疖无头疖no pustule23ppt课件Furuncle fjrk()l 疖Diagnosis：easyDifferential Diagnosis：1.1.acne with infectionacne with infection：fat on the tipfat on the tip，far follicefar follice 2.2.sebaceoussebaceous皮脂的皮脂的 cyst with infection cyst with infection：sebaceous

22、 glandsebaceous gland duct obstruction，epidermis normal，smelly 3.carbuncle 3.carbuncle：big rangebig range，mutiple mutiple hair folliclehair follicle24ppt课件Furuncle Prevention：keep skin clean Treatments：1.initial stage1.initial stage：physical therapyphysical therapy，overcoating overcoating 2.purulent

23、2.purulent：pick out pick out pus embolus 3.3.antibioticsantibiotics：Penicillin antibiotics Penicillin antibiotics，Bactroban ointmentBactroban ointment百多邦百多邦软膏软膏Attention：furuncle on the facefuruncle on the face（Dangerous Dangerous triangle triangle）,prevent squeezing,prevent squeezing25ppt课件Carbuncl

24、e Acute purulent infection of multiple neighbouring hair follicle and around tissue：most caused by S.amost caused by S.a（staphylococcal staphylococcal aureusaureus）symptoms：Middle age or oldMiddle age or old，red,swelling,hot and red,swelling,hot and pain,multiple pustulespain,multiple pustules，necro

25、sis on the necrosis on the centercenter；neck and backneck and back26ppt课件27ppt课件28ppt课件prevention：same with furuncleTreatments：1.1.antibiotics in timeantibiotics in time：intravenous,prevent sepsisErythrocin（红霉素）、（红霉素）、penbritin（氨卞青霉素），（氨卞青霉素），Cephalosporin antibiotics（头孢）（头孢）2.local processing2.loca

26、l processing：A.A.overcoating(ichthymallovercoating(ichthymall，magnesium magnesium sulfate)sulfate)；B.if purulentB.if purulent：incision inincision in“十十”shapeshapeTreatments29ppt课件Acute cellulitis Acute infection of loose connective tissue,happen in all parts of human body：beta hemolytic streptococcu

27、s beta hemolytic streptococcus、S.aS.a、E.cE.cSymptoms：acute，diffusibility，purulent SubcutaneousSubcutaneous SubfascialSubfascial intermuscular spaceintermuscular space Deep connective tissueDeep connective tissue30ppt课件Acute cellulitis Charcteristics Any parts of human bodyAny parts of human body Spr

28、ead quicklySpread quickly，hard to limithard to limit No obvious boundary line between No obvious boundary line between nidus and normal tissuenidus and normal tissue General symptoms are obviousGeneral symptoms are obvious31ppt课件Acute cellulitis Local Symptoms：inflammation symptomsinflammation sympt

29、oms，no obvious boundary lineno obvious boundary line CenterCenter：reder than edgereder than edge，blanch on pressure blanch on pressure SuperficialSuperficial：severe swelling but mild painsevere swelling but mild pain DeepDeep：mild swelling but severe painmild swelling but severe pain Neighbour lymph

30、anodeNeighbour lymphanode：largelargeGeneral symptoms ChillChill，FeverFever，headacheheadache，weakweak，general malaisegeneral malaiseSign：redred，edemaedema，painpain，crepitus crepitus 捻发音捻发音32ppt课件Acute cellulitis 33ppt课件Treatments lAntibiotics：CephalosporinsCephalosporins，Penicillin Penicillin，metroni

31、dazolemetronidazole（anaerobics anaerobics）lmagnesium sulfate（50%）wet dressing l Incision and drainagel Prevent complications34ppt课件Erysipelas Acute inflammation of Lymphocapillary network invaded by beta hemolytic streptococcusbeta hemolytic streptococcus 。There are always skin injury before,such as

32、 ulcerSymptoms：Fever，chill，general malaise，weak Lower limb，face；Signs：Skin inflammation、apophysis（微隆）、obvious boundary line、large lymph gland bright red，color degrade with finger press，recover with finger removed35ppt课件Erysipelas 36ppt课件Erysipelas Crus erysipelas Related with FilariasisRelated with

33、Filariasis（parasiteparasite）elephantedemaelephantedema37ppt课件erysipelasFilariasis丝虫丝虫 Lympho duct obstructionLympho depositelephantedemaErysipelas 38ppt课件Acute lymphadenitisAcute lymphangitisMicrobes invade lympha system StreptococcusStreptococcus，S.aS.a All partsAll parts Symptoms Symptoms：Acute ly

34、mphadenitis：Large lympha node、painlump、severe pain，skin red and hotabscess Acute lymphangitis：ExtremitiesSuperficial：skin red lineDeep：pain in a line shape39ppt课件Acute lymphangitis40ppt课件Treatments Lie in bedWith infected limb upPhysical therapyAntibiotics41ppt课件Abscess42ppt课件Abscess（1）Definition：Ac

35、ute purulent infectionAcute purulent infectionTissue necrosisTissue necrosisLiquid collectionLiquid collectionIf impeded drainageIf impeded drainage：nonunionnonunionS.AS.A(2)Symptoms：superficial：red，swelling，hot，pain，fluctuation deep：pain，pressing pain paracentesisUltrasonicGeneral symptoms43ppt课件Tr

36、eatments：1Incision and drainage：a:good looking b:suitable sizec:good for drainage d:avoid to injure nerve and vessel2.Drainage in incision：a：amount，color，changementb：change dressing until union3.General treatments：Large dose of antibioticsLarge dose of antibiotics4.Cold abscess：do not incise optiona

37、llydo not incise optionally，hard to unionhard to union，treat TBtreat TB44ppt课件Part 3Acute purulent infection of hands45ppt课件 Paronychia,prniki and felonParonychia：purulent infection of soft tissue around nailOne side nail groove，red，swelling，pain fluctuation another side，severe pain dumbbell abscess

38、 felon46ppt课件 Paronychia and felon 47ppt课件Treatments No abscess：no surgical，Ichthammol鱼石脂鱼石脂，physical therapy48ppt课件Part 4General purulent infection49ppt课件Definitions General purulent infection：Pathogenic bacteria is tremendousPathogenic bacteria is tremendous，virulence is strong virulence is strong

39、，human body can not human body can not eliminate themeliminate them，which reproduced in bloodwhich reproduced in bloodBacteremia：Small amount bacteria in blood,with mild virulence.Small amount bacteria in blood,with mild virulence.StrongImmunityStrongImmunityEliminate the bacteria quickly,no general

40、 reactionEliminate the bacteria quickly,no general reaction50ppt课件Definitions Toxaemia：The toxin of bacteria or the materia of tissue necrosion get into blood,not the The toxin of bacteria or the materia of tissue necrosion get into blood,not the bacteria,severe general reaction.bacteria,severe gene

41、ral reaction.Symptoms:Symptoms:Fever,sweat,thin Pulse,shock Fever,sweat,thin Pulse,shock Septicemia/Sepsis：The bacteria get into blood,reproduce and generate toxins,acute general The bacteria get into blood,reproduce and generate toxins,acute general infection.infection.Symptoms:Symptoms:Fever,sweat

42、,thin Pulse,shock Fever,sweat,thin Pulse,shock 51ppt课件Common pathogenic bacterias1、Gram-negative bacteria:Escherichia Coli(大肠杆菌大肠杆菌)、bacteroid拟杆菌、拟杆菌、Pseudomonas aeruginosa(绿脓杆菌绿脓杆菌)、proteus(变形杆菌变形杆菌)、Klebsiella pneumoniae(克雷伯菌克雷伯菌)、Enterobacter(肠杆肠杆菌菌)。abdominal cavity、intestinal tract、urinary syst

43、em2、Gram-positive bacteria:S.a、staphylococcus epidermidis(S.e)、enterococcus coccus3、anaerobic bacteria:abdominal abscess、appendicular abscess4、fungus:Candida albicans，opportunistic infection52ppt课件Symptoms Main:Main:Fever,sweat,thin Pulse,shock,dizzy,volmiting,delirium,Heart rate fast,rapid aspirati

44、onLab exams:Lab exams:White blood cell,acidosis,hemolysis,germiculture positive53ppt课件Clinical symptoms1、Gram-positive bacteria:Carbuncle,cellulitis High fever,Red face,limb warm,，delirium/coma，metastatic abscess2、Gram-negative bacteria:Bile duct、urinary tract、intestinal tract、burn woundschill，non-o

45、bvious fever，cold limb、cyanosis、shock early and long3、Fungus:Suprainfection，chill and fever suddenly(39.540)，worsen quickly、shock、blood test54ppt课件Diagnosis and treatmentsDiagnosis：Primary infection focalsymptoms Lab exams（germiculture）Treatments：1.Eliminate Primary infection focal，dead space，absces

46、s drainage2.Antibiotics：early+full dose+combination3.Supporting Therapy，blood volume，nultrition4.symptomatic therapy55ppt课件Part 5Special infections56ppt课件Tetanus Clostridium klstrdm tetani：anaerobic bacteriaexotoxin-sphacelotoxinand hematoxin（痉挛毒素、溶血毒素）Symptoms：latent stage 6-12 days，paroxysmal spas

47、m：sardonic sdnk facies（苦笑）opisthotonos,pistns（角弓反张）Caused by light and water,normal consciousness57ppt课件sardonic sdnk facies 58ppt课件Opisthotonos ,pistns角弓反张59ppt课件DiagnoseAccording to symptomsDifferential diagnosis1.1.purulent meningitispurulent meningitis：no spasmno spasm，severe headachesevere head

48、ache、feverfever、projectile vomitingprojectile vomiting、Cerebrospinal Fluid Cerebrospinal Fluid CSFCSF、whole blood testwhole blood test2.2.HydrophobiaHydrophobia（狂犬病）（狂犬病）：animal biteanimal bite60ppt课件Treatments 1.Wounds disposing2.Antitoxin：neutralization exotoxin neutralization exotoxin3.Avoild lig

49、ht，sound：sedative drug sedative drug，Spasmolysis drugSpasmolysis drug4.Complication prevention：asphyxia asphyxia sfsfksks、lung infectionlung infection，bone fracturebone fracture，may need may need tracheotomytracheotomy，assisted respirationassisted respiration5.Supporting Therapy：protein protein，ener

50、gyenergy，vitaminvitamin，fluid and electrolytefluid and electrolyte61ppt课件Gas gangreneThe cause：Spindle-shaped bacillus,often mix infectionsSpindle-shaped bacillus,often mix infections muscle necrosismuscle necrosis myositismyositis progress faster and have a poor prognosis.progress faster and have a