重度烧伤患者胃肠道细菌移位致全身感染的临床研究

Clinical study of gastrointestinal bacterial translocation-induced systemic infections in severe burn patients

目的调查重度烧伤患者胃肠道细菌移位致全身感染因素,为预防与治疗感染提供指导。方法收集2010年1月-2013年10月在医院接受治疗的重度烧伤患者60例,将其分为存活组(35例)和死亡组(25例),对两组患者感染程度进行比较。结果与存活组相比,死亡组患者的烧伤面积较大、烧伤指数较高、存在吸入性损伤、伴消化道出血及接受辅助呼吸治疗例数较多(P<0.05或P<0.01);存活组与死亡组的血清二胺氧化酶(DAO)分别为(1.71±0.34)kU/L与(1.94±0.51)kU/L、肠型脂肪酸结合蛋白(I-FABP)为(103.98±19.64)pg/ml与(115.56±21.75)pg/ml、内毒素为(0.14±0.02)kEU/L与(0.21±0.03)kEU/L和尿乳果糖/甘露醇(L/M)为(116.98±14.67)与(126.75±18.95)水平较高(P<0.05或P<0.01)。结论重度烧伤患者胃肠道屏障的损伤和细菌移位的程度与全身感染和预后密切相关。

OBJECTIVE To observe the gastrointestinal bacterial translocation‐induced systemic infections in severe burn patients so as to provide guidance for prevention and treatment of the infections .METHODS A total of 60 se‐vere burn patients who were treated in the hospital from Jan 2010 to Oct 2013 were enrolled in the study and divid‐ed into the survival group （35 cases） and the death group （25 cases）;the severity of the infections was compared between the two groups .RESULTS As compared with the patients in the survival group ,the patients in the death group had the larger burn area ,with the burn index higher ,and had inhalation injuries and gastrointestinal hemor‐rhage ,with a larger number of cases receiving the assisted breathing therapy （P〈0 .05 or P〈0 .01 ） .The level of serum diamine oxidase （DAO） was （1 .71 ± 0 .34 ）kU/L in the survival group ,（1 .94 ± 0 .51）kU/L in the death group;the level of intestinal fatty acid binding protein （ I‐FABP） was （103 .98 ± 19 .64）pg/ml in the survival group ,（115 .56 ± 21 .75）pg/ml in the death group ;the level of endotoxin was （0 .14 ± 0 .02 ）kEU/L in the sur‐vival group ,（0 .21 ± 0 .03 ）kEU/L in the death group;the lactulose/mannitol （ L/M ） was （116 .98 ± 14 .67） in the survival group ,（126 .75 ± 18 .95） in the death group（ P〈0 .05 or P〈0 .01 ） .CONCLUSION The systemic in‐fections and prognosis are closely associated with the degrees of injuries of gastrointestinal barriers and bacterial translocation of the severe burn patients .