严重烧伤患者早期短程应用高效抗生素的研究

目的探讨早期短程应用高效抗生素对严重烧伤后患者感染的防治效果。方法烧伤患者35例，烧伤面积50％～95％。根据高效抗生素使用时机分为早防组(20例，伤后6h内开始)和迟防组(15例，伤后48h开始)。动态检测血浆内毒素(lipopolysaccharide,LPS)、肿瘤坏死因子(TNFα)和白细胞介素-8(IL-8)的变化，严密观察脓毒症各项指标。结果大面积烧伤后血LPS、TNFα和IL-8明显升高，于伤后3～5d达高峰，但早防组明显低于迟防组(P＜0.05～0.001)。伤后2周内脓毒症、内脏并发症的发生率，早防组明显低于迟防组(P＜0.05)；伤后4～7d痂下组织菌量，早防组明显低于迟防组(P＜0.01)。结论严重烧伤早期短程使用高效抗生素，能有效预防烧伤后感染，并可降低内脏并发症的发生。

Clinical study on the early and short - term use of antibiotics with broad spectrum in severely burned patients

OBJECTIVE: To investigate the prevention and treatment effects of early and short -- term use of antibiotics with broad spectrum on postburn severe infection in severely burned patients. METHODS: Thirty -- five burn patients with TBSA from 50% to 95% were enrolled in the study. The patients were divided into early prevention [20 cases, antibiotics were used started from 6 postburn hours (PBH)] and delayed prevention (15 cases, antibiotics were applied after 48 PBH) groups. Plasma levels of LPS, TNFa and IL -- 8 were dynamically monitored with the concomitant observation of clinical signs of postburn sepsis. RESULTS: After major burns, the plasma levels of LPS, TNFalpha and IL -- 8 increased evidently and reached the peak values on 3 similar 5 postburn days (PBD). But the levels of all above factors in the early group were obviously lower than those in the delayed group (P < 0.05 similar 0.01). The incidencies of sepsis and internal organ complications within 2 postburn weeks were much lower in the early group than those in the delayed group (P < 0.05). The subeschar bacterial quantification on 4 similar 7 PBD was evidently lower in the early group than that in the delayed group (P < 0.01). CONCLUSION: Early and short -- term use of antibiotics with broad spectrum in severely burned patients could effectively prevent postburn severe infection and lower down the incidence of internal organ complications.