每日一题_2022.10.21

A 37-year-old man presented to the emergency department with a 1-week history of pain and swelling in the left upper arm that had started after blunt trauma during soccer practice. The heart rate was 120 beats per minute, the blood pressure 96/54 mm Hg, and the body temperature 37.9°C. Examination of the left upper arm was notable for swelling, tenderness, and crepitus. The overlying skin was red and warm to the touch. An initial radiograph is shown. Which of the following factors is most associated with increased mortality in this diagnosis? 患者男，37岁，因足球练习时钝性创伤后开始出现左上臂疼痛、肿胀1周急诊。心率120次/分，血压96/54 mmHg，体温37.9℃。左上臂检查发现明显肿胀、压痛和捻发音。被覆皮肤发红，触之发热。显示初始 X 线片。以下哪项因素与该诊断中死亡率增加最相关？

A. Involvement of the upper extremity

B. Dalay in surgical intervention > 24 hours

C. Negative blood cultures

D. Patient age < 60 years

E. Presence of erythema

答案解析：

正确答案是手术干预延迟 > 24小时。上臂 X 线片显示深部组织有气-液平面的透亮区，随后的计算机断层扫描显示伸肌间室肌肉有气泡，引起对坏死性肌炎的关注。该患者被送往手术室进行紧急手术清创，并确诊。广谱抗菌治疗3周后，患者恢复手臂功能。

正确答案：B