重度烧伤合并吸入性肺炎38例临床分析

Clinical analysis of severe degree burn complicated with aspiration pneumonia in 38 cases

目的分析重度烧伤合并吸入性肺炎患者的临床特点及治疗方法。方法 38例烧伤合并吸入性肺炎患者,在积极治疗烧伤的基础上,采用综合性个体化治疗方案,对患者的临床特征、治疗效果、并发症及病原学特征进行分析。结果38例中,治愈12例(31.6%),好转15例(39.5%),死亡11例(28.9%)。死亡原因主要为并发多脏器功能衰竭、难以纠正的呼吸衰竭、ARDS、心功能衰竭。本组并发症发生率高且严重,其中全身炎症反应综合征(SIRS)发生率高达68.4%,Ⅰ型呼吸衰竭为42.1%,脓毒血症为31.6%。22例患者应用呼吸机辅助呼吸。本组培养出致病菌48株,其中铜绿假单胞菌12例(25.0%),肺炎克雷白杆菌10例(20.8%),大肠埃希菌8例(16.7%),肺炎链球菌6例(12.5%),嗜麦芽假单胞菌4例(8.3%),金黄色葡萄球菌(16.7%)。对青霉素、头孢呋辛、头孢他啶、头孢噻肟耐药。结论重度烧伤合并吸入性肺炎患者病情复杂,并发症多且严重,病死率高,必须采用综合性个体化治疗措施,根据病原学早期、合理、足量应用敏感抗菌药物,并且积极应用呼吸机辅助呼吸。

Objective To analyze the clinical characteristics and treatment methods of severe degree burn complicated with aspiration pneumonia. Methods Based on the positive treatment on burn, the 38 cases of severe degree burn complicated with aspiration pneumonia received the comprehensive and individualized treatment plan. Their clinical characteristics, curative effects, eomplieations,and etiologic characteristics were analyzed. Results There were 12 patients （31.6%） cured, 15 ones （39.5%） improved, and 11 ones （ 28.9% ） died. The main causes of death were complicated with multiple organ failure, hardly corrected respiratory failure, ARDS, and heart failure. The incidence of complication was high and severe. The incidence of systemic inflammatory response syndrome （SIRS） was 68.4% ;that of type I respiratory failure was 42. 1% ;that of pyemia was 31.6%. There were 22 patients received assisted respiration by the respirator. Forty eight strains of bacteria were detected in this group including pseudornonas aeruginosa （ 25. 0% ）, bacillus canalis capsulatus （ 20. 8% ）, escherichia coli （ 16. 7% ）, streptococcus pneumoniae （ 12. 5% ） , pseudomonas maltophilia （8.3 % ）, and staphylococcus aureus （ 16.7% ）. Those bacteria were drug resistant to penicillin, cefuroxime, ceftazidime,and cefotaxime. Conclusion The patients with severe degree burn complicated with aspiration pneumonia have more severe complications and high death rate. Comprehensive and individualized treatment measures must be taken. Early reasonable and sufficient use of sensitive antibiotics must be carried out according to the drug sensitive examination. Respirator must be positively used for the assistant respiration.