高原地区烧伤创面细菌学调查分析

为了解高原地区烧伤创面的细菌学特点,笔者对本单位1998年5月～2 0 0 2年5月收治的12 4例烧伤患者创面分泌物进行了细菌学调查,现报道如下。资料与方法:本组患者中男85例、女39例,年龄8个月～5 4岁,烧伤面积2 %～85 %TBSA。创面处理以暴露疗法为主,个别部位予以包扎。用涂抹法采集标本,将创面分泌物加稀释液0 .2ml注入普通培养基,置35～37℃温育箱中培养2 4h,无细菌生长者再培养2 4h,仍无细菌则为无菌标本。细菌总数=每个平皿的集落形成单位×稀释倍数÷平皿底面积。共采集标本5 6 9份,采集时间分为冬、夏两季,其中夏季相对湿度为4 0 %～5…     

严重烧伤患者静脉导管感染的细菌学调查

1993～2000年笔单位对496例严重烧伤患静脉穿刺或静脉切开插管连续置管2d以上的静脉导管尖端进行细菌培养，有17例患发生导管脓毒症，发生率为3．23％，现报告如下。     

2004年全国烧伤创面修复与脓毒症专题研讨会纪要

2004年5月11～14日，全国烧伤创面修复与脓毒症专题研讨会在安徽省屯溪顺利召开。本次会议由中华医学会烧伤外科学分会与中华烧伤杂志编辑委员会组织，由中华烧伤杂志编辑部及安徽省烧伤分会共同承办。中华医学会韩晓明副秘书长及中华医学会杂志社姜永茂副社长出席了会议。大会来稿     

烧伤后期特大未愈创面伴脓毒症患者的救治

This article analyzed the medical records of a patient with 90％ TBSA unhealed wound accompanied with wound sepsis 50 days post burn (PBD) and to discuss the ideal strategies of treatment for such patients in such condition.This was a 24-year-old male patient suffering from flame burn with 95％ TBSA wound and severe inhalation injury.Meek skin grafting with autologous scalp was performed once to the thoracic and abdominal regions; intermingled skin grafting of autologous scalp microskin and large sheet of allograft was performed twice to the limbs within PBD 31.The patient was transferred to our hospital on PBD 50 with 90％ TBSA wound unhealed,leaving a vast amount of necrotic tissue and allografts.Furthermore,he was complicated by sepsis,pulmonary infection,and gastric ulcer.Debridement and allogenic skin grafting were performed on the first day after hospitalization.When the condition of wounds was improved,transplantation of a large sheet of allogenic skin with inlaid small pieces of autologous skin,intermingled skin grafting of autologous and allogenic skin,and small pieces of autologous skin grafting were performed.Because of the shortage of donor area,the exposed wounds were temporarily covered with allogeneic skin.Epidermal growth factor was used to promote the healing of autologous skin donor site and deep partial-thickness bum wound.Autologous skin grafting was performed whenever source of healthy skin was available.Systemic use of effective antibiotics,nutritional support and therapy,and other comprehensive measures also contributed to the success of treatment of this patient suffering from wound sepsis.The patient was cured and discharged on PBD 145.     

烧伤脓毒症的诊断标准与防治

烧伤脓毒症是大面积烧伤患者的严重并发症之一 ,也是诱发脓毒性休克、多器官功能障碍综合征(ＭＯＤＳ)的重要原因。烧伤脓毒症来势凶猛 ,病情进展快 ,病死率高 ,如何及时诊断及有效预防和治疗烧伤脓毒症 ,是提高烧伤救治成功率的关键。笔者就烧伤脓毒症的诊断标准和防治策略谈几点看法 ,供同道参考。一、烧伤脓毒症的诊断标准提出脓毒症诊断标准的目的 ,是在其发展为ＭＯＤＳ前及时发现并予以阻止。而作为诊断标准 ,首先不应太复杂 ,以免因不能开展某些检查项目而无法应用 ;其次应以客观指标为依据 ,能够真正反映烧伤患者的病情变化 ,有助于…     

雷电烧伤创面的特点及临床处理

雷电烧伤临床比较少见。在分类上，雷电烧伤一般归属于电烧伤，但其致伤原因复杂，创面特点和治疗方法与电烧伤有明显的不同。随着人们对雷电烧伤原因认识的逐渐深入，其治疗方法也在不断改进。     

外用湿润烧伤膏致创面脓毒症二例

例1　男,8岁。头、面、颈、躯干及双上肢被火焰烧伤。伤后6d在当地医院行双上肢切痂植皮术,躯干创面20%TBSA外用湿润烧伤膏(北京光明创疡研究所),2次/d。用药后3d,患儿出现高热,躯干创面糜烂、发黑、恶臭,于伤后10d转入笔者单位。查体:体温40℃,心率140次/min,患儿烦躁,谵妄,精     

小儿烧伤并发脓毒症的早期诊断及防治

脓毒症 (sepsis)是小儿烧伤最常见的并发症和死亡的最主要原因之一。资料显示 ,小儿烧伤脓毒症的发生率为 6 .4 % ,死亡率为 5 3% ,占总死亡率的6 0 % [1] 。由于烧伤后存在高分解代谢、免疫功能受损等因素 ,儿童又正处于生长发育阶段 ,各组织、器官的功能尚不完全 ,极易感染引起脓毒症 ,进一步导致多器官功能衰竭而死亡。因此 ,脓毒症的早期诊断及防治具有重要意义。一、预警指标脓毒症一旦发生 ,病情演进迅速 ,治疗难度大 ,因此近年来有很多关于脓毒症预警指标的研究 ,期望能够进行早期诊断和防治。1.血清C反应蛋白 (CRP)浓度测定 :CRP…     

烧伤脓毒症诊断与综合防治策略

Sepsis induced by invasive infection is a challenging problem and the major cause of death after severe burn.With the increasing understanding of sepsis,diagnostic criteria of sepsis were proposed and ...     

Clinical characteristics and treatment of burn wound sepsis in extensive burn patients: successful experience with eight cases

Eight burn wound sepsis patients, in which 6 cases were diagnosed as MODS and two as septic shock, were treated consecutively in our hospital from September 1997 to October 1998. The plasma concentration of IL-6, IL-8, TNFα and LPS were assayed before and after surgical intervention, as well as when the patients' vital signs became stable. The results showed: ①The patients' conditions abruptly deteriorated when the burn wound sepsis emerged;②The major cause related to burn wound sepsis was extensive burn injuries, with large areas of deep burn remaining open; ③Although wound swabs taken on admission revealed the presence of colonization by many pathogenic bacteria, Pseudomonas aeruginosa was one of the most frequent bacteria isolated from the subeschar tissue; ④The plasma concentrations of IL-6, IL-8, TNF and LPS before surgical intervention were significantly higher than that after surgical intervention (P＜0.05) ;⑤The lowest level of the inflammatory mediators was observed when the patients' conditions became stable, as compared with before surgical intervention (P＜0. 001).These findings suggest that the clinical characteristics of burn wound sepsis are abrupt deterioration of the general condition and prominent septic symptoms, often complicated by MODS. The main cause of burn wound sepsis is the presence of a large area of 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. Although success in treating these patients is the result of appropriate application of multiple treatments, early, aggressive and thorough surgical excision of invasive burn infectious tissue and closure of wound play a crucial role in the successful treatment of patients complicated by burn wound sepsis. Other treatments are adjuvant but also important.     

对烧伤感染的认识

Burn infection occurs when pathogenic bacte-ria colonized on the burn wound surfate,and they then invaded the viable tissue causing sepsis or sepsis with blood stream inva-sion.This infection pattern is particular to burn injury.Both in a model of pseudomonas burn wound sepsis and a clinical study of early eschar excision for bacteria quantification indicate that the bacteria not only are located on the burn wound surface but also invaded the deeper tissues.Finally,the bacteria penetrate into the neighboring viable tissue and even blood ves-sels.Therefore,we can say that burn infection is from local wound infection to invasive infection.and finally sepsis is devel-oped,and it is termed as burn wound sepsis.The cutoff count of subeschar tissue bacteria is 105/g.However,the burn wound sepsis may not occur when the number of subeschar tissue bacteria reaches 105/g.The criteria for the diagnosis of burn wound sepsis are mainly listed as below:(1)The number of bacteria in the subes-char reaches≥105/g.(2)Bacteria can be detected in the biopsy specimen.(3)Sepsis associated symptoms and signs.However,the sepsis associated symptoms and signs must be obvious in patients to make the clinical diagnosis of burn wound sepsis.If the sepsis associated symptoms and signs do not ap-pear.we should not make the diagnosis of burn wound sepsis e-ven with the number of bacteria in the subeschar tissue reaching 105/g or bacteria can be found in the biopsy specimen.Sepsis has been defined as the body's response to bacteria and their products.The occurrence of sepsis depends primarily on immune function and stress response intensity.and it is closely related to wound infection degree such as bacteria density and invasion depth in the burn wound,or plasma endotoxin level to certain extent.     

大面积侵袭感染组织切除对烧伤创面脓毒症患者静息能量消耗的影响

目的观察大面积侵袭感染组织切除对烧伤创面脓毒症患者高代谢的影响。方法对连续救治的8例烧伤创面脓毒症患者,分别于大面积侵袭感染组织切除前,手术后和病情稳定时,对静息能量消耗(restingenergyexpenditure,REE)白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子α(TNFα)、内毒素(LPS)进行监测。结果侵袭感染组织切除后REE水平[(307.7±31.3)kJ·h     

Effects of granulocyte colony-stimulating factor on bacterial translocation due to burn wound sepsis

The presence of certain defects in both cellular and humoral immunity after thermal injury has been established. Likewise, the translocation of enteric bacteria to the mesenteric lymph nodes and to distant organs has also been observed following serious thermal injury. The effects of granulocyte colony-stimulating factor (G-CSF) on bacterial translocation, the small bowel mucosa, and cecal bacterial content were investigated in a rat model of burn wound sepsis in which albino Wistar rats were scalded over 30% of their bodies, after which the lesions were infected by 1×10⁸ colony-forming units (cfu)Pseudomonas aeruginosa. The control group was treated with 5% dextrose solution subcutaneously starting 2 days preburn, while the treatment group received 100μg/kg human G-CSF subcutaneously. On the 4th day post burn all animals were killed to examine the bowel and culture of the mesenteric lymph nodes (MLN), livers, and spleens. No significant differences were observed between the groups regarding the cecal bacterial content and small bowel; however, a difference was seen in the ratio of translocation in the MLN liver and spleen and quantitative MLN cultures. Based on these findings, G-CSF was thus found to be significantly effective in reducing bacterial translocation due to burn wound sepsis.     

Variation in definitions of burn wound infection limits the validity of systematic review findings in burn care: A systematic review of systematic reviews

IntroductionSystematic reviews (SR) of high-quality randomised controlled trials can identify effective treatments for burn wound infections (BWIs). Clinical heterogeneity in outcome definitions can prevent valid evidence synthesis, which may limit the reliability of the findings of SRs affected by this heterogeneity. This SR aimed to investigate whether there is variation BWI definitions across studies in SRs of burn care interventions and its impact on identification of effective treatments for patients with burn injuries.MethodsA systematic search of five databases was conducted. Included SRs were: in English, published from January 2010 to October 2018, assessed intervention effects for patients with a burn injury, and reported data about BWI.ResultsTwenty-nine SRs, which included 248 studies reporting BWI outcomes, were included in our final dataset. Three SRs used a definition of BWI to select studies for inclusion. Fourteen reported BWI definitions from included studies in the review results. There was heterogeneity of BWI definition in their included studies; across 29 SRs, 32 different BWI indicators were used, with the median across SRs ranging from 1 to 7 (range 1–14). Fourteen SRs accounted for BWI definition heterogeneity in their conclusions, indicating that the issue impacted whether a conclusion could be drawn, and limited the validity of the SR findings.ConclusionsThere is variation in BWI definition across SRs and within the studies included in SRs of interventions assessing BWI outcomes. This heterogeneity has prevented conclusions about intervention effects being drawn, and only half of the SR authors have accounted for it in their findings. Reviews that have collated this data without reference to the heterogeneity should be viewed with caution, since it may limit the validity of evidence for the identification of effective treatments for BWI. The use of a newly developed core indicator set to support consistent reporting of indicators and standardisation of BWI outcome reporting will enable effective evidence synthesis.     

血浆冷沉淀物在深度烧伤创面应用的实验及临床研究

目的　观察血浆冷沉淀物应用烧伤创面的治疗效果。方法　通过对 4 0只豚鼠烧伤模型及 4 6例临床烧伤患者创面应用血浆冷沉淀物与创面应用磺胺嘧啶银对照观察伤后创面愈合率、愈合时间。结果　应用血浆冷沉淀实验组创面愈合率、愈合时间优于应用磺胺嘧啶银对照组 ,表明血浆冷沉淀具有促进烧伤创面愈合作用。结论　血浆冷沉淀中所含的主要成分纤维连接蛋白 ,具有很强的生物活性 ,它能促进上皮细胞生长     

The effect of extensive excision of burn wound with invasive infection on hypermetabolism in burn patients with sepsis

Objective: To evaluate the effect of extensive excision of invasive burn wound infection on hypermetabolic response in burn patients with sepsis. Methods:Eight patients with major burn, complicated by invasive burn wound infection and sepsis were consecutively admitted to our hospital from September 1997 to October 1998. REEs were monitored by means of Cardiorespiratory Diagnostic System (Medical Graphics Corporation, USA) at patients bedside. Plasma concentration of IL-6、IL-8、TNF-α and LPS were assayed before and after surgical intervention and at the time when the patients' vital signs became stable. Correlation analysis between REEs and IL-6、IL-8、TNF-α、LPS was respectively made. Results: A total of 8 patients were treated and all of them survived. Values of REE before surgical intervention were significantly higher than those after surgical intervention(P＜0.01), and when patients vital signs became stable the values were significantly lower compared with that after surgical intervention(P＜0.01). The plasma concentrations of IL-6、 IL-8、TNF-α and LPS after excision of invasive burn wound infection were significantly lower than those before surgical intervention (P＜0.05). The lowest levels of these 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). There was a significant positive correlation between REE level and respective values of plasma IL-6、 IL-8、 TNF-α、 LPS(P ＜0.01). Conclusions: It is deemed that the extensive excision of invasively infected burn wound in patients with major burn should be performed as early as possible to reduce an increased release of inflammatory mediators, and to control the hypermetabolic response during sepsis.     

烧伤早期创面细菌菌种分布及临床意义

目的 探讨近年来笔单位烧伤早期创面细菌菌种分布和临床意义。方法 215例严重烧伤患，在烧伤后6d内作首次创面细菌培养和药物敏感试验。结果(1)检出细菌122株，其中革兰阴性菌62株，革兰阳性菌60株；这些细菌包括凝固酶阴性葡萄球菌28株(占23％)，金黄色葡萄球菌27株(22％)，铜绿假单胞菌17株(14％)，大肠埃希菌11株(9％)，肠杆菌属10株(8％)，肠球菌属9株(7％)，霉菌3株(2．5％)，其他17株(14．5％)；(2)对氨苄青霉素、苯唑青霉素钠、羟氨苄青霉素／克拉维酸耐药的金黄色葡萄球菌耐药率分别为81％、38％和31％，对亚胺培南和头孢他啶耐药的铜绿假单胞菌分别占11％和16％；(3)革兰阳性球菌对万古霉素及去甲万古霉素、氯霉素、替考拉宁(Teicoplanin)、甲氧苄啶／磺胺甲基异恶唑、利福平的敏感率分别达到100％、100％、100％、94％和88％；革兰阴性杆菌对美罗培南、亚胺培南、丁胺卡那霉素、头孢吡肟、头孢哌酮／舒巴坦、头孢他啶的敏感率分别为91％、90％、81％、78％、71％和70％；铜绿假单胞菌对头孢哌酮／舒巴坦、头孢他啶、妥布霉素、美罗培南、环丙沙星、丁胺卡那霉素、头孢吡肟的敏感率在82％—91％之间；MRSA对万古雷素及去甲万古霉素全部敏感。结论 本单位近年来烧伤早期创面细菌以凝固酶阴性葡萄球菌和金黄色葡萄球菌为主，铜绿假单胞菌为次，这些细菌的耐药菌株明显增加；过去在烧伤早期创面较少见到的肠球菌属和霉菌亦有所增加。提示在烧伤早期必须正确使用抗生素，不宜滥用广谱抗生素。     

The evaluation of nasal mupirocin to prevent Staphylococcus aureus burn wound colonization in routine clinical practice

BackgroundStaphylococcus aureus wound colonization frequently occurs in patients with burns and can cause impaired wound healing. Nasal mupirocin application may contribute to the reduction of burn wound colonization of endogenous origin, whereas colonization by the exogenous route can be reduced by blocking cross-infection from other sources. In this study we evaluated whether the implementation of routine treatment of patients and burn center personnel using nasal mupirocin ointment reduces S. aureus burn wound colonization.MethodsWe composed three study groups, consisting of a control period (Control), a mupirocin period (MUP), in which patients with burns were all receiving nasal mupirocin at admission, and a mupirocin + personnel period (MUP + P), in which we also screened the burn center personnel and decolonized S. aureus carriers by nasal mupirocin.ResultsThe patients who carried S. aureus in their nose and did not have S. aureus burn wound colonization at admission were considered as patients susceptible for the use of nasal mupirocin. In these patients, the S. aureus burn wound colonization rate was the same in all study groups. S. aureus nasal carriage was a significant independent risk factor for burn wound colonization (OR: 3.3; 95% CI: 1.4–7.6) when analyzed within the three study groups.ConclusionAlthough S. aureus carriage is a significant risk factor for developing burn wound colonization, the routine use of nasal mupirocin did not contribute to a reduction of burn wound colonization.     

Potential of Curcumin nanoemulsion as antimicrobial and wound healing agent in burn wound infection

The review article concentrates on the potential uses of curcumin nanoemulsion in treatment and management of burn wound. Poor solubility and low bioavailability of curcumin limits the efficient and effective use of curcumin in management of bacterial infection related to burn wound. Nano particle based drug delivery system can be of great aid to solve this problem. Among this nanoemulsion is most favourable system due to its simplicity and low manufacturing cost. Nanoemulsion also enhances the skin permeation ability of curcumin and thus enhances its pharmacological efficacy specially as a potential antimicrobial agent, which can have applicability as a topical therapeutic agent in burn wound infection.