早期综合治疗对重度烧伤MODS发生的影响

目的探讨早期综合治疗对重度烧伤多脏器功能不全综合症（multiple organ dysfunction syndrome,MODS）发生的影响。方法选择2009年1月~2012年8月安徽医科大学第一附属医院烧伤科收治的重度烧伤患者（烧伤面积≥70%总体表面积（total body surface area,TBSA）、Ⅲ度烧伤面积≥30%）20例作为治疗组,应用早期有效充分液体复苏、尽早开始肠内营养和早期大面积切削痂有效覆盖创面的综合治疗方案;采用简单随机抽样方法,选取2009年前应用传统治疗方法治疗的重度烧伤患者20例作为对照组,两组具有可比性,观察两组患者MODS的发生情况。结果治疗组患者通过早期综合治疗方案的应用,创面脓毒症和MODS的发生率分别为40.0%和30.0%,明显低于对照组的80.0%和65.0%,差异均有统计学意义（均有P〈0.05）。结论早期有效充分液体复苏、尽早开始肠内营养和早期一次性大面积切削痂有效覆盖创面的综合治疗能降低重度烧伤MODS发生,提高治愈率,是重度烧伤早期合理、有效的治疗措施。

Effects of the early comprehensive treatment on multiple organ dysfunction syndrome (MODS) in extensively burned patients

Objective To explore the clinical effects of the early comprehensive treatment on MODS in extensively burned patients. Methods Twenty extensively burned patients（ burn area ≥ 70% TBSA and Ⅲ degree burn area ≥ 30% TBSA） were recruited from the department of Burns,the first affiliated hospital of Anhui Medical University from January 2009 to August 2012 as the treatment group. Patients in this group were treated with the early comprehensive treatment measures. These measures consist of rapid and adequate fluid resuscitation,early tube feeding and effectively covered wound after extensive eschar excision in one operation. The other 20 extensively burned patients（ burn area ≥ 70% TBSA and Ⅲ degree burn area ≥ 30% TBSA） before 2009 were included as the control group. Patients were treated with the traditional treatment measure in the control group. The incidence of MODS was compared between two groups. Results The incidence of sepsis and MODS were 40. 0% and 30. 0% respectively in treated group. It was evidently lower than that of the control group with significant differences（ P 0. 05）. Conclusions The early comprehensive treatment measure could reduce the incidence of MODS,and increase the cure rate. It will be a feasible and effective measure for extensively burned patients.