Gas gangrene is an acute and specific soft tissue infection caused by Clostridium bacteria. It is more common in severe open injuries of soft tissues. Chinese medicine classifies it as "grene". This disease mostly occurs after severe trauma to the muscle-rich areas of the lower limbs and buttocks. The incubation period is generally 1 to 4 days, but can be as short as 6 hours. (1) Etiology and pathogenesis Gas gangrene occurs in severe open injuries. Chinese medicine believes that after injury, the muscles are damaged and Qi and blood are weak, and the evil of fire poison takes advantage of the deficiency, resulting in the accumulation of fire poison, obstruction of muscles and vessels, and stagnation of Qi and blood, which is the root cause of the disease. 1. Invasion of evil poisons due to damage to the skin and flesh. Due to damage to the skin and flesh, evil poisons take advantage of the weakness and block the meridians. The affected limbs are numb, intermittent pain, and the whole body has symptoms of irritability, fever, and thirst. 2. Evil obstruction of tendons and meridians. Evil poison damages the meridians, causing weakness of Qi and blood, blood stasis and stagnation, making the skin around the trauma pale, tense and shiny, and then turns purple and dark, causing pain in the limbs, which is worse at night. 3. Heat poison accumulates, fire poison and blood stasis combine, rotten flesh and tendons, and even the heat poison invades the blood, causing the skin and tissues around the wound to turn black, and blisters with dark red liquid inside appear, and the wound may ooze fluid. Foul-smelling serous or bloody fluid. (2) Syndrome differentiation and diagnosis 1. Diagnostic Key Points: This disease can be diagnosed clearly based on medical history, local and systemic manifestations, and relevant examinations. (1) Medical history: Gas gangrene must have a history of trauma and wound contamination, and is seen in severe open injuries of soft tissues. (2) Clinical manifestations: Local manifestations: The wound is "swelling and cracking" with severe pain, which even cannot be relieved by analgesics. There is edema around the wound. The skin is pale, tense and shiny at first, then turns to dark purple, and finally turns to gray-black, with dark red fluid blisters appearing. Foul-smelling serous or serous fluid may flow out of the wound; Crepitus can be palpated in the surrounding skin, and bubbles can be seen flowing out along with exudate; the muscles are dark red, soft, and swollen; the limbs are cold, discolored, edema, and necrotic. Systemic manifestations: Patients present with fever, thirst, irritability, and general discomfort in the early and middle stages; in the later stages, they show extreme weakness, apathetic expression or restlessness, high fever, cold sweats, rapid pulse, and shortness of breath. Later, they may develop delirium, or even Coma, jaundice and obvious anemia may also occur, blood pressure may drop, and septic shock may occur in severe cases. The pulse is mostly frequent or thin, the tongue is red, and the coating is yellow and greasy. (3) Laboratory examination: Routine blood test shows obvious anemia; white blood cells increase, but not exceeding 12 000~15000/㎜; exudate smear can detect a large number of Gram-positive bacilli; anaerobic bacterial culture can confirm the diagnosis, but 2 Results will be available in ~3 days. (4) Pathological examination: necrotic muscles, air bubbles between muscles, and Gram-positive large bacilli can be seen. (5) X-ray examination: X-rays show the presence of gas in the muscle spaces. 2. Syndrome differentiation and classification (1) Heat invasion skin type (initial stage): The evil of heat and poison takes advantage of the deficiency, causing numbness and pain in the skin, exudate and smelly smell in the wound, general irritability, fever, thirst, and yellow coating. , red tongue, stringy or thready pulse. (2) Evil blocking the tendons and pulses (middle stage): The evil caused by heat and poison damages the tendons and blocks the pulses, causing blood stasis and stagnation, causing exacerbation of limb pain, the skin around the wound turning from pale to purple-black, and the amount of secretions increasing in smell and odor. It is also accompanied by initial systemic symptoms. (3) Heat-absorbed flesh-rot type (late stage): The evil of fire poison is strong and combined with blood stasis, the flesh rots and the tendons are destroyed, the skin around the wound turns gray-black, and foul-smelling serous or bloody liquid flows out of the wound. The whole body shows extreme weakness, cold sweats, irritability, high fever, rapid pulse, shortness of breath, and even coma, delirium, and other symptoms of heat poison entering the blood. (3) Treatment methods Once the disease is diagnosed, the following treatments can be performed: 1. Debridement involves removing discolored muscles and foreign bodies, and making extensive and multiple longitudinal incisions in the diseased area until healthy tissue with normal color and bleeding is reached. With the wound open, rinse or apply wet compress with large amounts of 3% hydrogen peroxide or 1:5000 potassium permanganate. Antibiotics can be used after surgery: tetracycline 2g daily, intravenous infusion; penicillin 10 million units, intramuscular injection or intravenous infusion in 4 to 6 times. 2. Traditional Chinese Medicine Treatment (1) Early and mid-stage: Heat invades the skin and pathogens block the muscles and veins. It is advisable to nourish yin and reduce fire, harmonize the body and detoxify, and use Jiedu Jisheng Decoction and Gubu Decoction. (2) Late stage: If the meat and rot are filled with heat, it is advisable to replenish qi and blood, relieve toxins and reduce swelling, and then add or subtract Tuoli disinfectant powder. 3. Other therapies (1) Systemic supportive therapy: high-protein, high-calorie and vitamin-rich foods, maintaining water and electrolyte metabolic balance, and multiple small-scale blood transfusions. (2) Hyperbaric oxygen chamber therapy: It can inhibit the growth, reproduction and toxin production of anaerobic bacteria. Treatment plan: 3 times on the first day, 2 times on the second and third days, 2 hours each time, with an interval of 6 to 8 hours. Debridement was performed after the first hyperbaric chamber treatment. (3) Amputation: In the later stages of the disease, when the muscles of the entire fascial cavity of the limb have been involved, or the injured limb is severely damaged, with comminuted fractures and large blood vessel damage, the arterial pulse has disappeared, and there is severe toxemia, it should be considered For high amputation, the stump is left open without suturing. Patients with gas gangrene should also be strictly isolated to prevent cross-infection. When toxemia occurs, gas gangrene antiviral serum can be used, but this product can only temporarily relieve toxemia, and there is a risk of allergy to horse serum, so it should be selected with caution in clinical practice.

Transmission route: (1) Air droplet and dust transmission A. Droplet transmission: When the patient exhales, talks loudly, howls, snores, coughs, or sneezes, a large amount of mucus containing pathogens can be sprayed from the nasopharynx. Droplets are small in size (about 15-100 μm) and remain suspended in the air for a short time (usually no more than a few seconds). When a person talks, about 170 droplets can be produced, which can fly 1 meter away and up to 1.2 meters. About 460 droplets are expelled when coughing, and up to more than 10,000 droplets are expelled when sneezing, which can be sprayed up to 9 meters away. Most of the droplets are water, and also contain a small amount of protein, exfoliated cells and germs. After these tiny droplets are discharged from the mouth, some of them are scattered on the ground. The smaller ones evaporate with water in the air, forming even smaller "droplet nuclei" suspended in the air, becoming the killer of spreading respiratory diseases. The scope of droplet transmission is limited to close contacts around the patient or carrier. Meningococcal meningitis, influenza, whooping cough, etc. can all be transmitted through this method. From a hygiene perspective, the optimal distance for conversation should be 1.3 meters. This will prevent you from contracting droplet-borne diseases through conversation. B. Transmitted by dust: Secretions containing pathogens are scattered on the ground in larger droplets and become dust after drying. On clothes, sheets, handkerchiefs or on the floor. When arranging clothes or cleaning the floor, dust carrying pathogens flies up and causes respiratory transmission. All pathogens that are resistant to desiccation can be transmitted through this method, such as Mycobacterium tuberculosis and anthrax spores. Most airborne infectious diseases are characterized by seasonal increases, and are generally more common in winter and spring. (2) Drinking water and food-borne pathogens are excreted through feces and contaminate water and food. Susceptible people are infected by eating contaminated food or drinking contaminated water. Bacillary dysentery, typhoid, cholera, hepatitis A and other intestinal diseases Infectious diseases are mainly spread through this method. (3) Contact transmission There are two modes of transmission: direct contact and indirect contact. Direct contact: Refers to some infectious diseases on the body surface that are transmitted through direct contact between the infectious source and the body of a susceptible person, such as touching, hugging, etc., such as scabies, chickenpox, etc., which are all infected through direct contact; in addition, some infectious diseases such as schistosomiasis , Leptospirosis can be transmitted through contact with "epidemic water" containing pathogens. The pathogens invade the body through the skin and mucous membranes, and are also transmitted by direct contact. Indirect contact: various intestinal infectious diseases, respiratory infectious diseases, head lice, conjunctiva Infectious diseases (pink eye), etc. are transmitted through hand contact or the use of daily items contaminated by the excrement or secretions of the infectious source, which is called indirect transmission. Dysentery and typhoid can be transmitted orally if the hands touch contaminated items. , hepatitis A and other intestinal infectious diseases; respiratory infectious diseases such as diphtheria, scarlet fever, influenza, etc. can be infected by having pathogen-containing droplets on your hands and then touching the mucous membranes of the mouth, nose, eyes, etc.; conjunctivitis, trachoma can be infected through vaginal use (4) The insect-borne pathogens reside in the body of insects for a period of time and then become infectious after reproduction. The pathogens enter the bodies of susceptible people through different invasion methods, such as mosquitoes, fleas, ticks, and scrub typhus. Insects such as mosquitoes are important vectors of transmission, such as mosquito-borne malaria, Japanese encephalitis, louse-borne typhus, flea-borne plague, etc. In addition, flies, cockroaches and other insects can also contaminate food through the intestinal infectious pathogens they carry. This causes the spread of diseases such as bacillary dysentery and typhoid (5) Blood/body fluid transmission, such as hepatitis B and C, through blood transfusions, syringes used for drug use, loosely sterilized tattoos, ear piercing or sexual intercourse. , AIDS, etc. (6) Vertical transmission: Vertical transmission is also called mother-to-child transmission. The pathogen enters the fetus from the mother, causing the fetus to be infected, such as congenital syphilis, AIDS, etc. (7) There are many opportunities for soil contamination, such as congenital syphilis. Human manure fertilization causes enteric disease pathogens or parasite eggs to contaminate the soil, such as hookworm eggs, roundworm eggs, etc.; spores of certain bacteria can survive in the soil for a long time, such as tetanus, anthrax, gas gangrene, etc., if In case of skin damage, infection can occur through soil. 3. Susceptible groups: Susceptible groups refer to people who lack immunity to a certain infectious disease and are susceptible to the disease. For example, some children who have never had measles are susceptible to measles. Susceptible groups.