严重烧伤延迟复苏脓毒症防治的临床研究

目的　对烧伤延迟复苏患者脓毒症的发生情况进行临床分析 ,旨在进一步降低烧伤后脓毒症的发生率。方法　将 72例延迟复苏的严重烧伤患者分二个阶段 ,即 1990年 4月— 1994年 12月 (第一阶段 ,n =2 6)及 1995年 1月— 2 0 0 1年 12月 (第二阶段 ,n =46) ,进行比较分析。结果　第二阶段烧伤治愈率升高 ,创面愈合时间及住院时间缩短 ,主要内脏器官并发症发生率及脓毒症发病率明显下降 ,血清肿瘤坏死因子(TNF)水平下降 (P <0 .0 1～ 0 .0 5 )。结论　早期、快速、有效的液体复苏 ,早期削 (切 )痂 ,早期肠内喂养 ,加强营养支持治疗和进行免疫调理 ,合理应用抗生素 ,输注经紫外线照射的异体全血 ,重视防治内源性感染和减少有创性诊疗操作等均可降低烧伤延迟复苏患者脓毒症的发生率。

An Clinical Study the Prevention and Treatment of Sepsis on Severely Burned Patients with Delayed Fluid Resuscitation

Objective To study the prevention and treatment of sepsis on severely burned patients with delayed fluid resuscitation.Methods From january 1990 through December 2001,altogether 72 cases delayed fluid resuscitation were admitted to our burn department.Two different periods were divided and analyzed retrospectively.Results (1)The survival rate of the second period was very significantly higher than that of the first period.But incidence of sepeis,the rate of complication of major visceral organ including heart and lung and gastrointestin were very significantly lower than those of the first period ( P <0. 01～0. 05 ).(2)The time of wound healing in the second period was lower than that of the first period.(3)The serum TNF was increased at all times in two periods and was markedly increased in the first period ( P <0 01～0. 05).Conclusion Our data demonstrate that measures taken in the second period for patients with delayed fluid resuscitation,including early excision,early rapid adequate resuscitation,early enteral feeding,inreased immunity function,early applying antibactials,Xenotransfusion of ultrariolet irradiated blood(XUIB),application of rh GH,EGF,bFGF,are beneficial to the prevention and treatment of sepsis on severely burned patients with delayed fluid resuscitation