严重烧伤延迟复苏多器官功能障碍综合征的防治

Comprehensive treatment on patients with mutiple organ dysfunction syndrome after delayed fluid resuscitation

目的探讨成功救治严重烧伤延迟复苏(指烧伤后6h开始的液体复苏治疗)患者的治疗方法。方法将72例严重烧伤延迟复苏的患者按不同时期治疗措施的不同分成常规组及综合组,进行比较分析。结果综合组血清肿瘤坏死因子α(TNF-α)、乳酸(BLA)、肌酐(C r)、尿素氮(BUN)、丙氨酸氨基转移酶(ALT)、肌酸激酶同工酶(CK-MB)下降,碱缺失(BD)上升。与常规组比较综合组治愈率高,心、肺、胃肠等主要脏器并发症发生率及脓毒症发病率明显下降(P<0.01和0.05)。结论快速有效的综合复苏、早期削(切)痂植皮术及早期保护主要内脏器官功能、扶持机体免疫功能和防治脓毒症等构成的综合救治方案有利于改善心肌酶谱、肝功、肾功,进而降低MODS的发生率,降低MODS的病死率。

Objective To summarize the therapy of severly burned patients with mutiple organ dysfunction syndrome（MODS） after delayed fluid resuscitation.Methods Seventy-two severly burned patients with MODS and delayed fluid resuscitation were divided into Group Ⅰ（routine treatemt group） and Ⅱ（comprehensive treatment group） in the retrospective study.Creatine kinase isoenzyme（CK-MB）,Creatinine（Cr）,blood urea nitrogen（BUN）,alanine aminotransferase（ALT） and tumor necrosis factor-α（TNF-α） were determined.Results（1）The survival rate of Group Ⅱ was significantly higher;fatal rate and incidence of sepsis,MODS and major visceral organ complication were significantly lower in Group Ⅱ than in Group Ⅰ（P0.01 or P0.05）.（2）Serum levels of CK-MB,ALT,BUN and Cr were evidently lower in Group Ⅱ than in Group Ⅰ（P0.01 or P0.05）.（3）The serum TNF-α and blood latic acid（BLA） were increased more markedly in Group Ⅰ（P0.01 or P0.05）.Conclusion The survival rate of severly burned patients is increased significantly due to improvement in compound resuscitation regime,early escharectomy,protection of major visceral organ function,immune function increase and prevention against sepsis.