摘要
目的 为提高烧伤创面脓毒症的治疗水平 ,研究并总结烧伤创面脓毒症的临床特点及救治经验。方法 自 1997年 9月～1998年 10月我科共连续收治 8例烧伤创面脓毒症患者 ,全都救治成功 ,其中 6例并发多器官功能障碍综合征 (MODS) ,2例并发脓毒性休克 ,在这些患者中 ,感染组织切除前、切除后、生命体征平稳时分别对创面及痂下组织的菌种进行了培养和分离 ,并测定了血浆白细胞介素 6(IL 6) ,白细胞介素 8(IL 8)、肿瘤坏死因子 (TNF)和内毒素(LPS)。结果 ( 1)烧伤患者一旦发生创面脓毒症 ,病情急剧恶化 ;( 2 )烧伤面积大 ,深度面积广 ,焦痂或痂皮存在时间长、创面未能得到及时覆盖是诱发创面脓毒症的主要因素 ;( 3 )虽然导致创面感染的病原菌有多种 ,但绿脓杆菌是侵袭痂下附近健康组织的主要致病菌 ;( 4 )坏死、感染组织切除前血浆IL 6、IL 8、TNF、LPS水平较切除后为高(P <0 0 5 ) ,生命征平稳时上述炎性介质水平低于坏死、感染组织切除后 (P <0 0 5 ) ,更低于坏死、感染组织切除前 (P<0 0 0 1)。结论 烧伤创面脓毒症常并发MODS,深度烧伤创面未能得到及时切除、封闭是诱发本症的根源 ,而炎性介质在烧伤创面脓毒症发生发展过程中扮演了重要角色。及时、果断、彻底切除坏死组织 。
Objective To further improve the treatment of burn wound sepsis Methods Eight patients with burn wound sepsis, of whom 6 with MODS and two with septic shock, were treated consecutively in our hospital from September 1997 to October 1998 The plasma concentrations of IL 6, IL 8 TNF and LPS were assayed before and after surgical intervention and at the time when the patients' vital signs became stable Results (1) The patients' conditions abruptly deteriorated when the burn wound sepsis emerged. (2) The major causative factor related to burn wound sepsis was extensive burn injuries, with large area of deep burn remained open. (3) Although colonization by multiple pathogenic bacteria was found, Pseudomonas aeruginosa was the most frequent bacteria isolated from the subeschar tissue. (4)The plasma concentrations of IL 6, IL 8, TNF and LPS before surgical intervention were significantly higher than those after surgical intervention ( P <0 05); (5)The lowest level of the inflammatory mediators were observed when the conditions of patients became stable, and the values were significantly lower compared with those before surgical intervention ( P <0 001) Conclusions The main cause of burn wound sepsis is the presence of a large area of infected open deep burn wounds, which should be excised and covered early LPS and pro inflammatory mediators play an important role in the pathogenesis of burn wound sepsis Favorable results in the treatment attribute to appropriate application of multiple treatments, and early, aggressive and thorough surgical excision of invasive burn infectious tissue and closure of wounds play a crucial role
出处
《中华医学杂志》
CAS
CSCD
北大核心
1999年第12期908-910,共3页
National Medical Journal of China
基金
全军医药卫生科研基金!98M15 5
关键词
烧伤
创面脓毒症
治疗
Burns Burn wound sepsis Treatment Experience
