大面积烧伤多脏器功能衰竭防治的临床研究

Clinical study on the prevention and cure of multiple systems and organs failure of extensive burn

目的：探讨如何防治烧伤后多脏器功能衰竭，提高大面积烧伤治愈率。方法：总结了我院１９８０ ～１９８７ 年烧伤面≥３０ ％ 病例１８１ 例为组１ 和１９９６ ～１９９８ 年≥３０ ％ 烧伤病例１４６ 例为组２ 的两组病例临床资料。治疗中主要的不同是组１ 休克期输液量少于１９７０ 年全国烧伤会议制定的标准，而组２ 则大大超过这一标准。组１ 切痂后用猪皮打洞嵌自体皮而组２ 切痂后用微粒皮肤移植覆盖创面。结果：组１ 烧伤死亡率为２７－６ ％ ，ＭＳＯＦ２１ 例，死亡１９ 例。组２ 烧伤死亡率２－７ ％ ，ＭＳＯＦ１ 例，死亡１ 例。烧伤后ＭＳＯＦ 有两个高发期，即早期（ 伤后７ 天内，其初始因素主要为休克） 和晚期（ 伤后２１ 天后，主要为感染引起） 。结论：一旦发生ＭＳＯＦ，预后极差，因此应将预防作为重点。其关键在于及时有效地抗休克和正确合理地创面处理。休克期输液量平均应大于１９７０ 年全国烧伤会议制定标准的２０ ％ 左右。微粒皮肤移植技术的应用因较好地解决了Ⅲ°创面的覆盖问题，大大降低了大面积烧伤ＭＳＯＦ 的发生率。

Objective:To discuss how to prevent and cure multiple systems and organs failure(MSOF) after burn and to increase the cure rate of extensive burn.Methods:Two groups of extensive burn patients(the burn area≥30%)in different periods were studied in our hospital.One hunderd and eighty\|one cases of 1980～1987 were in group one and 146 cases of 1996～1998 were in group two.The principal treatment method was different in two groups.The infusion quantity of shock stage was distinctly less than the standard of the nation wide burn meeting in 1970 in group one.But the infusion quantity was distinctly more than the standard(mean 1 76 ml/1%TBSA/kg).Pig dermis with hole and autologous epidermis were used in skin graft after removal of eschar in group one.Microne skin graft was applicated to overlay the surface of wound in group two.Results:In group one,burn mortality was 27 6%,the patients with MSOF were 21 cases,19 cases died of MSOF.In group two,burn mortality was 2 7%,the patients with MSOF was only 1 case,the patient died of MSOF.MSOF after burn had two peak periods.The major factor of early period(in seven days) was shock.The major factor of late period(21 days after burn) was infection.Conclusion:Once MSOF happens in extensive burn,its prognosis will be very poor.So the prevention in recognized to be the most important.It is the key to treat effectively the shock in time and treat surface of wound correctly and rationally.The mean infusion quantity of shock stage is more about 20% than the standard of the nation wide burn meeting in 1970.Overlay of Ⅲ°surface of wound is solved by the appllication of microne sking graft technology.So the incidence rate of MSOF after extensive burn is greatly lowered.