八例烧伤创面脓毒症的治疗经验

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例烧伤创面面脓毒症患者，全部救治成功，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

Treatment of invasive burn wound infection with sepsis:a clinical study

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