大面积烧伤休克期切痂对抗感染的影响

EFFECT OF ESCHARECTOMY AND SKIN GRAFTING DURING BURN SHOCK STAGE ON CONTROLLING INFECTION

为证实休克期切痂有控制感染的作用，对比了休克期切痂组（３８例）和非休克期切痂组（４１例）的临床治疗效果。结果表明：休克期切痂组①抗生素应用种类少，时间短，病死率低，愈合时间短；②脓毒症、多系统器官功能衰竭、骨髓炎、静脉导管培养和血培养阳性率低；③ＩＬ－６、ＩＬ－８、血浆内毒素和肿瘤坏死因子水平都低于非休克期切痂组。痂下组织细菌定量，休克期切痂组为４．６×１０２ＣＦＵ／ｇ，非休克期切痂组为８．４×１０３ＣＦＵ／ｇ。

In order to demonstrate the effect of escharectomy during burn shock stage and on controlling infection in patients with major burns,we compared theraputic effects in two groups of patients with extensive burn.Among them 38 patients (70 0±16 1)% TBSA,Ⅲ° (41 0±17 3)% underwent escharectomy during the shock period,and the other 41 patients (65 1±18 3)% TBSA,Ⅲ°( 42 5±20 1)% on the 4th day postburn. The results showed that smaller amounts of the antibiotics were required,mortality were reduced,healing time were shortened,incidences of sepsis,MSOF,osteomyelitis,positive venous cathter culture,positive blood culture were lowered in group A than in group B.Level of IL 6,IL 8,LPS and TNF were lowered in group A than in group B.Subeschar bacterial count showed a mean of 4 6×10 2CFU/g in acute shock stage,and 8 4×10 3CFU/g on the 4th day postburn.Based on the above study,we believe that escharectomy during burn shock stage is satisfactory in regard to prevention of infection and sepsis.