早期切痂对重度烧伤患者静息能量消耗的影响

目的　应用代谢车动态观察烧伤患者早期切痂植皮对静息能量消耗 (REE)的影响。方法　根据首次切痂植皮时间 ,将 5 6例重度烧伤患者分为早期切痂植皮组 (A组 ,39例 ,伤后 5d内手术 )和非早期切痂植皮组 (B组 ,17例 ,伤后 5d后手术 )。首次切痂时将Ⅲ度及其周围深Ⅱ度创面全部切除 ,切痂后创面用异体皮加自体微粒皮覆盖。在治疗期间应用新型代谢车床旁动态监测患者REE变化 ,同时检测 9例A组患者和 7例B组患者的血浆白细胞介素 (IL)6、IL 8、肿瘤坏死因子α(TNF α)、内毒素 脂多糖 (LPS)等变化。　 结果　全部病例治愈 ,尽管两组患者REE均明显升高 ,但A组在切痂前、后及伤后 14d内REE明显低于B组 (P <0.0 5 )。A组患者血浆IL 6、IL 8、TNF α、LPS水平明显低于B组 (P <0.0 5 )。　 结论　大面积深度烧伤患者早期切痂植皮可在一定程度上降低机体的高代谢状态 ,其原因可能与及早封闭创面从而减少多种炎性介质的过度释放有关。

The effects of early escharectomy on resting energy expenditure in the severely burned patients

OBJECTIVE: To investigate the effect of early escharectomy on resting energy expenditure (REE) in severely burned patients dynamically with the metabolic monitoring and diagnostic system. METHODS: Fifty-six adult male patients with severe burns were divided into early escharectomy (group A, n = 39, escharectomy within 5 PBDs) and non-early escharectomy (group B, n = 17, escharectomy after 5 PBDs) groups. The wounds of full thickness and deep partial thickness burn in the two groups were all excised and covered with allogeneic skin and autologous micro-skin in the first operation. The changes in REE were observed dynamically at the bedside of the patients with the metabolic monitoring and diagnostic system. The plasma contents of IL-6, IL-8, TNF-alpha and LPS from 9 patients in group A and 7 in group B were also determined dynamically. RESULTS: All patients survived. The REE in both groups was elevated markedly, but REE in group A was lower compared with group B before and after escharectomy within 14 days. (P < 0.05). The plasma level of IL-6, IL-8, TNF-alpha and LPS in group A were obviously lower than those in group B (P < 0.05). CONCLUSION: The hypermetabolic response of burn patients with severe burns could be lowered by early escharectomy, and it seemed to be related to the decrease of the release of proinflammatory mediators.