严重延迟复苏烧伤脓毒症的早期综合防治

An early comprehensive prevention and treatment of sepsis in severely burned patients with delayed fluid resuscitation

目的 探讨提高延迟复苏烧伤脓毒症治愈率的早期防治措施。方法 将 72例延迟复苏的严重烧伤患者分为两个阶段进行分析。 1990年 1月— 1994年 12月为第一阶段 (n=2 6 ) ,1995年 1月— 2 0 0 1年12月为第二阶段 (n=4 6 ) ,对两个阶段的复苏情况、脓毒症发生率及预后进行比较分析。结果 第二阶段脓毒症发生率 (17.4 % )及病死率 (6 .5 % )均较第一阶段 (分别为 5 7.7%和 2 3.0 % )明显下降 ;休克纠正时间也明显缩短 ,分别为 (1.9± 0 .9) h和 (6 .6± 2 .5 ) h,血清肿瘤坏死因子 (TNF)水平也明显下降 (P<0 .0 5或 P<0 .0 1)。结论 早期、快速、有效的液体复苏 ,早期削 (切 )痂 ,早期肠内喂养 ,加强营养支持治疗和进行免疫调理 ,合理应用抗生素 ,输注经紫外线照射的异体全血 ,重视防治肠源性感染等措施 ,均可降低脓毒症的发生率 ,提高脓毒症的治愈率。

ObjectiveTo study an early comprehensive prevention and treatment of sepsis in severely burned patients with delayed fluid resuscitation. MethodsFrom January 1990 to December 2001, 72 cases of patients with delayed fluid resuscitation were admitted to our burn department.Two different periods were divided and analyzed retrospectively. The first period was from January 1990 to December 2001 and the span of the second period was from January 1995 to December 2001. Results①The mortality rate and incidence of sepsis in the second period (6.5% and 17.4%) were significantly lower than those of the first period(23.0% and 57.7%,P<0.05 and P<0.01). ②The time of wound healing in the second period was(1.9±0.9) hours,it was lower than that of the first period(6.6±2.5) hours. ③The serum contents of tumor necrosis factor(TNF) and blood lactic acid(BLA) were increased at all times in two periods and were markedly increased in the first period (all P<0.01). ConclusionOur data demonstrated that measures adopted in the second period for patients with delayed fluid resuscitation,including early excision,early rapid adequate resuscitation ,early enteral feeding,increased immunity function,early applying antibactials, xenotransfusion of ultrarioletirradiated blood,application of recombinant humangrowth factor (rhGH) , epidermal growth factor(EGF),basic fibroblast growth factor(bFGF),are beneficial to the prevention and treatment of sepsis in severely burned patients with delayed fluid resuscitation.