重度烧伤患者合理使用抗生素最佳时机探讨

目的探讨严重烧伤患者合理使用抗生素最佳时机的选择。方法根据烧伤病程的不同时期,依据“全面覆盖、重拳出击、策略换药、早用敢停”合理使用抗生素,每期3~5天,并随时根据细菌学资料和药敏结果选择敏感抗生素。结果本组50例,死亡2例,其余48例均治愈出院,平均住院天数37.8天。102次血培养和127次创面培养分离出不同细菌32种。休克期、感染期、和脓毒症期以G-菌为主。溶痂期以G+菌为主。结论休克期、感染期、围手术期、脓毒症和溶痂期是选择使用抗生素的最佳时机,应早用敢停。头孢他啶、头孢吡肟(马斯平)、泰能、奈替米星和左旋氧氟沙星策略换用能减少耐药菌株的产生,提高杀菌敏感性。

TO DISCUSS THE BEST OCCASION OF USING RATIONALLY ANTIBIOTICS ON SEVERE BURN PATIENTS

Objective To discuss how to select the best occasion of using rationally antibiotics on severe burn patients.Methods ①select the antibiotics by different periods in the course of burn patients;②use antibiotics by broad spectrum,enough dosage,strategic dressing,early using and reasonable stopping;③use 3～5 days each term,quickly select sensitive antibiotics by bacterial culture and medicine sensitive results.Results This set 50 cases,2 died,the rest 48 all cured and discharged,average hospitalization time is 37.8 days.And 32 kinds of different bacteria had been separated from 102 blood and 127 injuried surface cultures.In shock stage,infection stage,pyemia stage G-germ is the main.Dissolve crust stage G+ germ is the main.Conclusion Shock stage,infection stage,perioperative stage,pyemia stage and dissolve crust stage are all the best occasions of using antibiotics,which should be early start and rationally stop.Alternative using ceftazidime,cefepime,tienam,netilmicin and levofloxacin can reduce medicine resistance and improve curative effect.