依据临床指标对大面积烧伤病人施行休克期切痂植皮

Performing escharectomy following“clinical guidelines”in extensively burned patients during burn shock stage

目的验证依据临床指标对大面积烧伤病人施行休克期切痂植皮的可行性。方法对33例大面积烧伤病人在无 Swan-Ganz 导管监测条件下,当获得下述临床标准时开始施行休克期切痂:①尿量80～100ml/h;②意识清楚;③口渴明显减轻;④无消化道症状;⑤心率100～110次/min;⑥呼吸平稳,20～24次/min;⑦血红蛋白≤150g/L,红细胞压积≤0.5。与另32例非休克期切痂组病人对比,观察两组病人脓毒症、MODS 的发生率和炎性介质内毒素(LPS)、肿瘤坏死因子(TNF)、血浆白介素6(IL-6)、白介素8(IL-8)的动态变化。结果 33例休克期切痂病人术后病情均稳定,脓毒症的发生率低于非休克期切痂组(34.4%:56.3%),MODS 的发病率及死亡率也较非休克期切痂组为低,血浆 LPS、TNF、IL-6、IL-8水平显著低于非休克期切痂组。结论依据临床指标指导休克期切痂,安全可靠,可减少脓毒症和 MODS 的发生,提高治愈率。

Objective To verify the practicability of performing escharectomy on extensively burned patients during shock stage following the clinical guidelines only.Method Sixty-five burn patients with total body surface area(TBSA)over 30% received resuscitation to prevent and treat burn shock without hemodynamic monitoring.Clinical indexes of optimal resuscitation,such as a urine volume 80 to 100 ml/h,heart rate around 100 to 110/min,respiration rate 20 to 24/min,significant alleviation of thirst,sense of nausea and vomiting,clear mentality,Hb≤150g/1 and Hct≤0.50 were adopted as guide- lines,under which thirty-three patients underwent escharectomy and grafting during burn shock stage (group A).For comparison,other 32 patients received escharectomy 96hr after injury(group B).The inci- dences of sepsis and MODS were analyzed.Plasma samples from 12 patients in group A and 9 patients in group B were assayed at interval for LPS,TNF,IL-6 and IL-8.Results All 33 patients in group A were in stable condition,and the incidence of sepsis was lower(34.4%)than that in group B(56.3%).The in- cidence of MODS and the mortality of patients in group A was lower than those in group B.Levels of LPS,TNF,IL-6 and IL-8 in plasma were lower in group A as compared with those in group B.Conclusion The results show that escharectomy could be performed during shock stage under clinical guidelines with reasonable safety.