烧伤早期脏器损害发病机制的探讨

STUDY ON THE PATHOGENESIS OF POSTBURN ORGAN DAMAGE

烧伤后脏器损害是当前烧伤主要的死亡原因，其发病机制尚未完全阐明。本研究认为其本质是缺血缺氧性损害；血液灌流不足与肠源性感染是其主要发病因素；失控性炎症反应是其基本病理生理变化；血管内皮细胞起关键作用。改善早期复苏方案，应用延迟快速补液可改善脏器血液灌流，应用早期肠道营养能减轻肠道损害，有助于防止肠源性感染；伤后尽快一次切除大部分焦痂能减轻失控性炎症反应。

Postburn organ damage presents the most important lethal factor of burn injury. However, its pathogenesis is not fully clear now. The results of our studies suggested that postburn organ damage was resulted primarily from ischemia and cellular hypoxia. Inadequate blood perfusion and inflammatory reaction presented the basic pathophysiologic change and vascular endothelial cells played a key role in the development of postburn organ damage. It was found that early enteral feeding could effectively prevent the gut damage and decrease the incidence of enteral bacterial translocation. Early excision of eschar en masse (EEE) at one operation was used in 35 cases with major burns. The results strongly substantiated that the EEE was effective in preventing early postburn oragn damage by attenuating systemic inflammation response syndrome and alleviating endothelial cell injury.