摘要
目的:通过对48例大面积烧伤后延迟复苏患者的前瞻性研究,评价改进休克复苏方案对延迟复苏后脓毒症和多器官功能障碍综合征(MODS)防治效果。方法:1992年至1999年我科首诊收治的延迟复苏(伤后6h或6h后开始补液)病人48例,对比分析采用改进休克复苏方案治疗与未采用改进方案治疗患者脓毒症和MODS发生率和病死率。改进后的休克复苏方案包括:①Swan-Ganz导管监测下的快速有效复苏。②山莨菪碱的早期大量应用。③氧自由基清除剂VitC、VitE和甘露醇的大量使用。结果:1992年以后,使用新方案治疗显著缩短了休克纠正时间,提高了复苏成功率。抽样观察结果显示,新方案可显著提高胃粘膜pH值,降低血中丙二醛、二胺氧化酶和内毒素水平;从总的治疗效果来看,降低了患者脓毒症和MODS发病率和病死率。结论:改进的休克复苏方案提高了复苏效率,减轻了延迟复苏时缺血及重灌流造成的损害,进而有效降低了脓毒症和MODS发病率和病死率,提高了患者生存率。
We try to elucidate the effect of improved resuscitation measures on the morbidity and mortality of sepsis and MODS, through analysis of extensively burned patients with delayed fluid resuscitation ad-mitted to our burn institute in a period of 8 years. Methods: 48 extensively burned patients admitted to the depart-ment from Oct. 1992 to Dec. 1999 were involved in this study. All these patients had delayed fluid resuscitation (fluid infusion began at or later than 6h after the injury). Morbidity and mortality rates of sepsis and MODS were compared between two groups of patients with and without improved resuscitation measures. These measures in-cluded: ①Prompt, rapid, and adequate fluid resuscitation under hemodynamic monitoring with Swan-Ganz cathe-ter. ②Rapid restoration of bowel circulation with anisodamine. ③Prevent further OFR injury to various tissues with OFR scavengers using Vitamin C, Vitamin E, and mannitol. Results: With the application of the improved re-suscitation measures, the morbidity rate of MODS was decreased from 45.5 (10/22) to 19.2%(5/26), and the mortality rate from 90.0%(9/lb)to 60%(3/5). In the same time , the morbidity rate of sepsis was also signifi-cantly reduced(54.5%and 26.9%, respectively). Gastric intramucosal pH was significantly higher, but plasma MDA, DAO and endotoxin levels were significantly lower in patients treated with new measures than that without on postburn day 1 and 3. This indicates that the new measures can effectively extenuate OFR injury, restore intes-tinal barrier function and prevent endotoxin translocation from the gut, which may contribute to the favorable out-come. Conclusion: Improved resuscitation measures can effectively extenuate ischemie and reperfusion injury, de-crease morbidity and mortality rates of patients with delayed fluid resuscitation after extensive burns.
出处
《感染．炎症．修复》
2000年第1期7-10,共4页
Infection Inflammation Repair
基金
全军九五医药卫生指令性课题资助项目(96L053)
