烧伤脓毒症休克期创面切痂手术与延期手术的临床对照研究

Clinical controlled study on the escharectomy and delayed operation of the burn wounds during the stage of sepsis shock

目的研究在脓毒症休克期对烧伤患者实施创面切痂,同时植皮封闭创面的可行性及必要性。方法收集2008年9月至2014年12月我院收治的大面积烧伤合并脓毒症患者52例,在患者休克期进行抗休克治疗,同时积极手术切痂植皮的患者27例为休克期手术组;脓毒症休克期暂缓手术、休克期稳定后延期施行手术的25例患者为延期手术组,对比2组患者术后脏器功能指标(肌酐、谷丙转氨酶等),血液分析,术后血浆降钙素原(PCT)及白细胞介素-6(IL-6)水平;比较2组患者创面愈合率及术后血乳酸水平、多器官功能障碍综合征(MODS)发生率、病死率。结果休克期手术组患者手术后PCT、IL-6下降,病情平稳,术后MODS发生率、病死率较延期切痂组明显降低,其脏器功能指标及创面愈合率也显著优于延期手术组,差异有统计学意义(P<0.05)。结论对烧伤脓毒症休克期患者积极抗休克同时实施手术切痂,清除坏死组织,可有效减缓创面侵袭性感染、缩短病程,降低MODS发生率及病死率,从而提高治愈水平。

Objective To investigate the feasibility and necessity of escharectomy and skin graft in sepsis shock stage in burn patients. Methods Fifty-two patients with large area burns coupled with sepsis,hospitalized for treatment from September,2008 to December,2014 in our hospital were selected for the study. When the patients displayed signs of shock,they were given anti-shock treatment and at the same time received escharectomy and skin grafting. Collection of medical data was made in 25 severe burn patients,who had delayed escharectomy during sepsis stage and received surgery when the state of illness became stable. Comparisons were made between the 2 groups in the indices of postoperative organ function（ creatinine,ALT）,blood analysis,postoperative plasma PCT（ Procalcitonin） and interleukin 6（ IL-6） levels,as well as wound healing rate and postoperative blood lactic acid level,incidence of multiple organ dysfunction syndrome（ MOD） and mortality rate. Results The levels of PCT and IL-6 after surgery for the escharectomy group were decreased,and the state of illness was stable. Incidence of MODS after surgery and mortality were significantly lower than those of the delayed escharectomy group,and the indices of organ functions as well as wound healing rate were all significantly superior to those of the delayed escharectomy group. Conclusion To the burn patients at sepsis shock stage,active anti-shock measures coupled with escharectomy and skin grafting,removal of the necrotic tissue could not only decrease mortality,increase cure rate,decrease invasive wound infection,but shorten the course of disease,reduce incidence of MODS and mortality,thus increasing cure rate.