[A case of cerebral infarction after deep burn tangential excision and skin grafting]

A female patient aged 42 years with deep burn on right lower limb was admitted to Affiliated Hospital of Jining Medical University on January 25, 2019. The patient previously had cerebral infarction, hypertension, and hysteria, with long-term use of aspirin and risperidone. After admission, the patient underwent tangential excision twice. On the third day after the second tangential excision and skin grafting, the muscle strength of the right limb gradually decreased, and the patient was treated with emergency craniocerebral magnetic resonance imaging, which suggested acute cerebral infarction. Improvement of cerebral circulation and vasodilatation were given immediately. The limb muscle strength of the patient gradually recovered on the fifth day after the operation, and no sequela was left when the patient was discharged. After the case was discussed, we think that postoperative decreased blood volume and blood concentration resulting from tangential excision bleeding of deep burn and wound exudate as well as inadequate fluid infusion are the main causes of hemodynamic change, the patient had the basis of multiple cerebral artery stenosis, and superposition of multiple factors led to the occurrence of postoperative acute cerebral infarction. Appropriate increase in the fluid infusion volume during and after surgery and transfusion if necessary to increase blood and oxygen supply to the brain can reduce the occurrence of cerebral infarction.2019年1月25日，济宁医学院附属医院收治1例42岁女性右下肢深度烧伤患者，患者既往患有脑梗死、高血压、癔症等疾病，长期服用阿司匹林、利培酮。入院后先后2次行削痂手术，在第2次削痂植皮术后第3天出现右侧肢体肌力减弱，急诊行颅脑核磁共振成像，提示急性脑梗死，立即给予改善脑循环、扩血管等处理。术后第5天患者患肢肌力逐渐恢复，出院时未遗留后遗症。笔者团队对此病例进行讨论，认为深度烧伤削痂出血和术后创面渗出导致血容量降低、血液浓缩及不充分的补液导致脑血流动力学改变为主要诱因，多发脑动脉狭窄为基础，多种因素叠加，导致术后急性脑梗死的发生。术中及术后适当增加补液，必要时输血以增加脑部供血供氧，可减少此类脑梗死的发生。.