患者男性，34岁，因“火焰烧伤全身多处，疼痛4小时”来诊。烧伤面积占总体表面积（TBSA）的89%，除头部（3%）、下腹部（2%）、会阴（1%）、臀部（2%）、足底部（3%）为正常皮肤外，其余全部为烧伤创面，四肢以Ⅲ度烧伤为主，前、后躯干以深Ⅱ度烧伤为主。查体：面颈部肿胀明显，声音嘶哑，鼻毛烧焦，咽部充血反应明显。四肢肿胀明显，呈皮革样，指（趾）末端皮温降低。体温36.5℃，呼吸28次/分，心率135次/分，血压100/75mmHg（1mmHg=0.133kPa），血氧饱和度92%。
提示：患者伤后8小时，气管切开后呼吸平稳，导管吸氧下血氧饱和度98%～99%，经静脉补液抗休克后血流动力学相对平稳，尿量40～50ml/h。进一步合适的处理方式是（）
A.全身创面清创磺胺嘧啶银外涂创面暴露
B.四肢切痂，微粒皮移植术
C.冷疗
D.四肢减张切开
E.双手切痂自体皮肤移植术
F.全身清创，抗生素纱布包扎
参考答案：A, D
The party began shortly after Mr. Wood, who lived in the flat below, signed (叹息) to himself as he heard excited voices and the noisy music. Luckily he had ___1___ some work home from the office, ___2___ he kept himself busy for a couple of hours, thus managing to pay no attention to the noise___3___ . But by eleven o’clock he felt ___4___ and was ready to go to bed, though from his earlier experience he knew it was ___5___ trying to get to sleep. He undressed and lay for a while on the bed, trying to read, but he___6___ himself reading the same page over and over again. He then turned off the light and ___7___ his head in the pillow(枕头). But ___8___ he could not shut off the ___9___ ，finally after ___10____ seemed hours his___11___ was gone. He jumped out of bed, __12__ some clothing, marched ___13___ up the stairs and walked into his neighbor’s flat. The owner of the flat, who ___14___ him in his dressing gown(睡衣) came ___15___ the room and__16___ Mr. Wood could say anything, cried “My dear fellow, come and ___17___. I know our parties ____18___ you. I meant to send you ___19___.” Mr. Wood’s anger disappeared then and there. He said “I’d better go and get __20_.” Minutes later, he returned properly dressed, only to find that the party was nearly over.
|