中药对重症烧伤感染及抗菌药物使用影响的临床研究

Clinical Study on Effect of Chinese Herbal Medicine on Severe Burn Infection and Application of Antimicrobial Agents

目的:观察中药在烧伤重症阶段对烧伤感染指标、抗菌药物使用和耐药菌出现的影响。方法:选取108例重症烧伤患者,使用回顾性的方法,根据患者中药使用情况,将患者分为中药+西医治疗的综合治疗组(综合组) 60例,及单纯西医治疗组(西医组) 48例,根据病例及医嘱系统的内容,提取患者的治疗资料进行分析,对比2组患者白细胞(WBC)、超敏C-反应蛋白(hs-CRP)、前降钙素(PCT)、急性胃肠功能损伤(AGI)评分、重症监护室(ICU)住院率、抗菌药物使用情况。结果:与西医组比较,综合组WBC、hs-CRP、PCT、AGI评分、ICU住院率等指标均较优,但仅WBC、AGI评分比较,差异有统计学意义(P<0.05)。与西医组比较,综合组抗菌药物使用强度(AUD)较低,非限制级抗菌药物累计用药频度(DDDs)占所在组总DDDs比率较高,而限制级、特殊使用级抗菌药物的DDDs占比较低,差异有统计学意义(P<0.05);综合组多重耐药菌总出现率较低,但差异无统计学意义(P>0.05)。火毒炽盛、热入营血、阴阳两虚为烧伤重症阶段的主要证候,中药以清热凉血、养阴益气药物为主。结论:中西医结合治疗烧伤的感染控制更加理想,抗菌药物使用较为合理,耐药菌出现率较低。

Objective: To observe the effect of Chinese herbal medicine on indexes of burn infection, application of antimicrobial agents and appearance of resistant bacteria in severe stage of burn. Methods:A total of 108 cases of patients with severe burn were retrospectively analyzed and divided into the comprehensive treatment group that combined with Chinese and western medicine(the comprehensive group) and the simple western medicine treatment group(the western medicine group) according to the application of Chinese herbal medicine, 60 and 48 cases in each group respectively.According to the cases and medical orders,the treatment data of patients were extracted and analyzed;the scores of white blood cell(WBC),high-sensitivity C-reactive protein(hs-CRP),procalcitonin(PCT) and acute gastrointestinal injury(AGI),the Intensive Care Unit(ICU) hospitalization rate and the application of antimicrobial agents in the two groups were compared.Results:Compared with those in the western medicine group,the scores of WBC,hs-CRP,PCT and AGI as well as the ICU hospitalization rate in the comprehensive group were better,but only the scores of WBC and AGI showed significance in the difference(P<0.05). Compared with those in the western medicine group, the antimicrobial use density(AUD) in the comprehensive group was lower, and the cumulative defined daily doses(DDDs) of unrestricted antimicrobial agents accounted for a higher proportion of the total DDDs in the comprehensive group,while DDDs of restricted and special-uselevel antimicrobial agents accounted for a lower proportion,differences being significant(P<0.05);the total occurrence rate of multi-drug resistant bacteria in the comprehensive group was lower, but there being no significance in the difference(P>0.05). The main syndromes of severe burn were intense fire toxin, heat entering nutrient-blood aspects and dual deficiency of yin and yang;Chinese herbal medicine are mainly for clearing the nutrient aspect and cooling the blood aspect as well as tonifying yin and qi. Conclusion:In the comprehensive group,the infection control was better,the application of antimicrobial agents was more reasonable,and the occurrence rate of drug-resistant bacteria was lower.