儿童口腔颌面部狗咬伤的治疗

doi:10.12016/j.issn.2096-1456.2019.08.007

口腔疾病防治 ›› 2019, Vol. 27 ›› Issue (8): 510-514.DOI: 10.12016/j.issn.2096-1456.2019.08.007

儿童口腔颌面部狗咬伤的治疗

张同韩¹,刘晓玲²,吴纪楠¹(),陈觉尧¹,苏葵¹,郑巧仪¹

^1. 中山大学附属中山医院口腔分院口腔颌面外科，广东中山（528403）
^2. 中山大学附属中山医院内科重症监护室，广东中山（528403）

收稿日期:2019-01-16 修回日期:2019-03-24 出版日期:2019-08-20 发布日期:2019-08-16
通讯作者: 吴纪楠
作者简介:张同韩,副教授,博士,Email:zthlove1982@163.com
基金资助:
中山市社会公益科技研究医疗重大专项(2017B1008)

Treatment of oral and maxillofacial dog bites in children

ZHANG Tonghan¹,LIU Xiaoling²,WU Jinan¹(),CHEN Jueyao¹,SU Kui¹,ZHENG Qiaoyi¹

^1. Department of Stomatology, Affiliated Zhongshan Hospital of Sun Yat-sen University, Zhongshan 528400, China;
^2. Department of Medical Intensive Care Unit, Affiliated Zhongshan Hospital, Sun Yat-sen University, Zhongshan 528400, China.

Received:2019-01-16 Revised:2019-03-24 Online:2019-08-20 Published:2019-08-16
Contact: Jinan WU

摘要/Abstract

摘要：

目的总结儿童口腔颌面部狗咬伤的治疗经验,为临床提供参考。方法对2011年7月—2018年6月期间收治的狗咬伤口腔颌面部的19例儿童患者行一期清创缝合,同时给予狂犬病疫苗、破伤风疫苗及被动免疫制剂人源免疫球蛋白肌肉注射,并使用阿莫西林克拉维酸钾等抗炎治疗,并进行随访及回顾性分析。结果 19例儿童患者,经过治疗后18例一期愈合,1例二期愈合,随访半年至7年半,患儿面容恢复较好、未发生狂犬病。结论对于狗咬伤口腔颌面部患儿的治疗,一期清创缝合减轻了术后瘢痕,有利于面容的恢复。

关键词: 狗咬伤, 颌面部外伤, 儿童, 清创术, 一期缝合, 狂犬病, 疫苗, 被动免疫制剂

Abstract:

Objective To summarize experience treating dog bites in the oral and maxillofacial regions of children and provide a reference for clinical practice. Methods Nineteen children with dog bite wounds in the maxillofacial region were treated from July 2011 to June 2018 with primary debridement and suturing. A rabies vaccine, tetanus vaccine and human immunoglobulin as a passive immune agent were given via intramuscular injection. Anti-inflammatory therapy with amoxicillin and clavulanate potassium or other antibiotics. Follow-up observation and a retrospective analysis of the treatment effect were carried out. Results After treatment, among the 19 pediatric patients, 18 cases showed primary healing and 1 case showed secondary healing. The follow-up period ranged from six months to seven and a half years. No cases of rabies occurred. Conclusion For the treatment of patients with maxillofacial dog bite wounds, the first stage debridement and suture can reduce the scar after operation and is beneficial to the recovery of face.

Key words: dog bite, facial trauma, children, wound debridement, primary suture, rabies, vaccine, passive immunization

中图分类号:

R782

张同韩,刘晓玲,吴纪楠,陈觉尧,苏葵,郑巧仪. 儿童口腔颌面部狗咬伤的治疗[J]. 口腔疾病防治, 2019, 27(8): 510-514.

ZHANG Tonghan,LIU Xiaoling,WU Jinan,CHEN Jueyao,SU Kui,ZHENG Qiaoyi. Treatment of oral and maxillofacial dog bites in children[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2019, 27(8): 510-514.

图/表 3

图1 3岁男童被狗咬伤颌面部一期清创治疗前后 a~c：手术前照片; d：术后即刻照片; e、f：术后11个月随访照片

Figure 1 Images of a 3-year-old boy before and after one-stage debridement after being bitten by a dog in the maxillofacial region

图2 4岁男童被狗咬伤左颌面腮腺区一期清创治疗前后

Figure 2 Images of a 4-year-old boy before and after one-stage debridement after being bitten by a dog in the maxillofacial region

图3 1岁男童被狗咬伤一期清创治疗前后 a、b：手术前照片; c、d：术后即刻照片; e、f：术后随访22个月照片

Figure 3 Images of a 1-year-old boy before and after one-stage debridement after being bitten by a dog in the maxillofacial region

参考文献 19

[1]	Shen JB, Li SH, Xiang HY , et al. A Multi-Site study on knowledge, attitudes, beliefs and practice of child-dog interactions in rural China[J]. Int J Environ Res Public Health, 2013,10(3):950-962.
[2]	Yadav AK, Jaisani MR, Pradhan L , et al. Animal inflicted maxillofacial injuries: treatment modalities andour experience[J]. J Maxillofac Oral Surg, 2016,16(3):356-364.
[3]	Lin W, Patil PM . Facial dog attack injuries[J]. Indian J Surg, 2015,77(1):55-58.
[4]	Pitt KA, Stanley BJ . Negative pressure wound therapy: experience in 45 Dogs[J]. Vet Surg, 2014,43(4):380-387.
[5]	黄新生 . 颌面部狗咬伤100例临床治疗体会[J]. 中国伤残医学, 2009,17(5):62-63.
[6]	唱荣艳. 周花 . 颌面部犬咬伤患儿围手术期护理[J]. 中国美容医学, 2009,18(4):567.
[7]	Agrawal A, Kumar P, Singhal R , et al. Animal bite injuries in children: review of literature and case series[J]. Int J Clin Pediatr Dent, 2017,10(1):67-72.
[8]	邱蔚六 . 口腔颌面外科学[M]. 5版. 北京: 人民卫生出版社, 2003: 166.
[9]	Nel LH, Markotter W . Lyssaviruses[J]. Crit Rev Microbiol, 2007,33(4):301-324.
[10]	Heitz C, Louzada GP, Conci RA , et al. Primary repair of a complex panfacial fracture by dog bite[J]. Plast Reconstr Surg Glob Open, 2018,6(4):e1719.
[11]	欧笑梅, 曾晓花, 何适欣 , 等. 犬咬伤急诊护理进展[J]. 医学动物防制, 2017,33(4):399-402.
[12]	Bharti OK, Madhusudana SN, Wilde H . Injecting rabies immunoglobulin (RIG) into wounds only: a significant saving of lives and costly RIG[J]. Hum Vaccin Immunother, 2017,13(4):762-765.
[13]	Morgan M, Palmer J . Dog bites[J]. BMJ, 2007,334(7590):413-417.
[14]	Chaudhry MA, Macnamara AF, Clark Clark . Is the management of dog bite wounds evidence based? A postal survey and review of the literature[J]. European J Emergency Med, 2004,1111:313-317.
[15]	Thibault LP, Rousseau E . Dog bites[J]. CMAJ, 2018,190(4):E113.
[16]	李智强, 党娜 . 小儿头部犬咬伤合并脑脊液漏一期缝合2例[J]. 中国临床神经外科杂志, 2018,23(2):143.
[17]	贾亿卿, 陈瑞丰, 黄立嵩 . 苯扎氯铵在犬咬伤伤口清创中的应用效果观察[J]. 解放军医学院学报, 2018,39(7):618-620.
[18]	Bhattacharya V . Management of soft tissue wounds of the face[J]. Indian J Plast Surg, 2012,45(3):436-443.
[19]	Kuvat SV, Bozkurt M, Kapi E , et al. Our treatment approaches in head-neck injuries caused by animal bites[J]. J Craniofac Surg, 2011,22(4):1507-1510. DOI

儿童口腔颌面部狗咬伤的治疗

Treatment of oral and maxillofacial dog bites in children

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

图/表 3

参考文献 19

相关文章 15

编辑推荐

Metrics

[1]	唐雅文,张琳,杨雪,邹静,王艳. 急性淋巴细胞白血病患儿的口腔健康管理[J]. 口腔疾病防治, 2021, 29(8): 572-576.
[2]	刘颖,夏大弘. 武汉市1~3岁儿童龋病管理社区家庭医生模式初探[J]. 口腔疾病防治, 2021, 29(6): 406-410.
[3]	邓宇杰,杨晓彬,陈浩,赖金环,周苗. 口腔门诊治疗中1 429例患者应用笑气镇静技术的回顾性分析[J]. 口腔疾病防治, 2021, 29(4): 249-253.
[4]	周庆楠,尚佳健. 菌斑微生物群落构成变化与儿童龋病相关研究进展[J]. 口腔疾病防治, 2021, 29(4): 267-272.
[5]	施宏燕,何翔,黄蕊,张颖. 龋风险评估在上海市闵行区儿童龋病分级管理中的效果评价[J]. 口腔疾病防治, 2021, 29(1): 50-56.
[6]	朱少军,热娜·买买提,张蓓,王智亨,葛金莲,刘奕杉. 重度低龄儿童龋患者铁锌铜及维生素D的血清水平[J]. 口腔疾病防治, 2020, 28(8): 506-509.
[7]	林曦,郑相淮,徐淑兰. 儿童及青少年的牙种植进展[J]. 口腔疾病防治, 2020, 28(11): 728-732.
[8]	束煌,王骥,陈婵婵,邝亦元,丁桂聪. 笑气联合咪达唑仑在儿童埋伏多生牙拔除术中的镇静效果[J]. 口腔疾病防治, 2019, 27(5): 304-308.
[9]	杨婷,张婉婷,李贝贝,董英,曹宏飞,赵今. 博尔塔拉蒙古自治州儿童口腔变形链球菌的分布及其与龋病的相关性研究[J]. 口腔疾病防治, 2019, 27(4): 219-225.
[10]	李珍珍,刘姗姗,张凯. 低龄儿童龋研究进展[J]. 口腔疾病防治, 2019, 27(4): 260-263.
[11]	张帆,任伟伟,管琴,赵慧,李守宏. 共同参与模式对牙科畏惧症儿童就诊行为的管理[J]. 口腔疾病防治, 2019, 27(2): 104-106.
[12]	肖小芬,何姗丹,陈泳怡,吴晓云,郑雨燕. 不同龋敏感程度学龄前儿童的牙菌斑微生物群落研究[J]. 口腔疾病防治, 2019, 27(12): 763-768.
[13]	曾欣,宋宇,于艳玲,蔡长宇,林静. 全瓷嵌体修复儿童第一恒磨牙严重缺损的效果[J]. 口腔疾病防治, 2018, 26(9): 578-583.
[14]	韩轩, 霍媛媛, 张琼, 邹静（审校）. 低龄儿童龋致龋微生物相关生物标志物的研究进展[J]. 口腔疾病防治, 2018, 26(6): 391-395.
[15]	束煌, 杨峰, 王骥, 肖宇寒, 丁桂聪. 学龄期腭裂儿童的事件相关电位研究[J]. 口腔疾病防治, 2018, 26(4): 236-239.