大面积烧伤后多器官功能障碍综合征的临床防治

Prevention and treatment of MODS in severely burned patients:an institute based retrospective study

目的 将临床与实验研究所得结果应用于临床治疗 ,分析其对降低严重烧伤患者多器官功能障碍综合征 (MODS)发病率的作用。 方法 总结自 1970年 1月至 1999年 10月共收治的严重烧伤 (烧伤面积均大于 30 %TBSA)患者 6 5 7例 ,以 1990年 1月 1日为界分为 2组。 2组的伤情有可比性。 1990年 1月至 1999年 10月之间的患者广泛地应用了新的治疗措施 ,主要为及时、快速、充分的液体复苏 ,应用山莨菪碱恢复肠道血供 ,氧自由基清除剂阻止氧自由基的损害 ,休克期广泛切痂、植皮 ,早期经口营养 ,主要器官功能支持等。 结果 1990年 1月前 36 9例 ,MODS的发病率为 17 3% ,病死率为 87 5 % ;1990年 1月至 1999年 10月之间 2 88例的MODS发病率为 6 9% ,病死率为 40 0 % ,两组结果差异有显著意义。 结论 严重烧伤患者在治疗中减轻或消除MODS的病因或诱因的措施 ,可以显著地降低MODS的发病率。

Objective[WT5”BZ] To determine if the preventive and treatment measures developed from basic and clinical research work have any effects on the incidence and outcome of MODS in severely burned patients. [WT5”HZ]Methods[WT5”BZ] 657 extensively burned patients (burn size exceeding 30%TBSA) admitted to the clinical department from January 1970 through October 1999 were studied. The morbidity and mortality rates were compared in patient groups hospitalized before and after January 1990 when major preventive and treatment measures began to be extensively executed. These measures consisted of prompt, rapid and adequate fluid resuscitation, restoration of bowel blood supply with anisodamine (654 2), use of oxygen free radical scavengers (e.g. mannitol, vitamin C and E), extensive escharectomy during shock stage, early tube feeding, support of organ function, etc. [WT5”HZ]Results[WT5”BZ] Before 1990 when very few preventive and treatment measures were applied, the incidence of MODS, 17 3% (64 out of 369), and the death rate 87 5% (56 out of 64) After 1990, with the application of various preventive measures and treatment, the morbidity and mortality rates were reduced to 6 9% (20/288) and 40 0% (8/20), respectively. [WT5”HZ]Conclusion[WT5”BZ] Our results suggest that measures which mitigate or eliminate the predisposing and causative factors of MODS may be salutary in the prevention and treatment of MODS after extensive burn injury. [WT5”HZ]