综合防治方法预防和治疗严重烧伤患者脓毒症和多器官功能障碍综合征的效果分析

Effectiveness analysis of the comprehensive prevention and treatment of sepsis complicated by multiple organ dysfunction syndrome in 65 severe burned patients

目的:观察采用综合防治方法(早期液体复苏、抗感染、清创、创面覆盖、早期肠内营养等)预防和治疗严重烧伤后并发脓毒症和多器官功能障碍综合征(MODS)的临床效果。方法:回顾性分析2017年1月—2019年12月武警上海市总队医院烧伤科收治的特重度烧伤患者(烧伤面积≥50%TBSA,Ⅲ度烧伤面积≥20%TBSA)65例的临床资料。给予患者早期有效液体复苏,局部外用抗菌药物,早期大面积切、削痂和同种异体皮或异种皮及时覆盖创面,尽早开始肠内营养,减少氧自由基损害、控制过度炎症反应等综合措施,观察治疗结果和脓毒症、MODS的发生率。结果:65例严重烧伤患者治愈62例(95.38%),死亡3例(4.62%);发生脓毒症10例(15.38%),MODS 6例(9.23%)。结论:采用综合治疗措施,即早期充分液体复苏和坏死组织的彻底清除,根据分泌物细菌培养和药敏结果选择全身、局部应用的抗菌药物,早期有效覆盖创面及肠内营养等,对预防和治疗严重烧伤后脓毒症及MODS具有较好的效果。

Objective: To explore the clinical efficacy of comprehensive methods(fluid resuscitation in early stage,anti-infection, debridement, wound coverage, early enteral nutrition, and so on) for preventing and controlling sepsis complicated by multiple organ dysfunction syndrome(MODS) after severe burns. Methods: Sixty-five severe burned patients(burn area≥50% TBSA and Ⅲ degree burn area≥20% TBSA) were collected from No. 3 department of Surgery,Armed Police Corps Hospital of Shanghai from Jan. 2017 to Dec. 2019, and their clinical data were retrospectively analyzed. The patients were treated with comprehensive treatment measures, including rapid and adequate fluid resuscitation, topical application of antimicrobials, effectively covered wound after extensive eschar excision in one operation, early tube feeding and reducing oxygen-radical induced injury, control of excessive inflammatory response.The treatment results, incidences of sepsis and MODS were observed. Results: The 65 severe burned patients received comprehensive treatments, 62(95.38%) of them were treated successfully, 3 died(4.62%);10 suffered from sepsis(15.38%) and 6 did MODS(9.23%). Conclusions: The comprehensive treatment measures such as rapid and adequate fluid resuscitation in early stage, topical application of antimicrobials, effectively covered wound after extensive eschar excision and early tube feeding will be an effective in reducing the incidence of sepsis and MODS for severe burns.