Cumming J, Purdue G F, Hunt J L, O'Keefe G E
Department of Surgery, Division of Burn, Trauma, and Critical Care, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
J Trauma. 2001 Mar;50(3):510-5. doi: 10.1097/00005373-200103000-00016.
Organ dysfunction and sepsis are frequent after major burn trauma, represent quantifiable consequences of the systemic response to injury, and may be important end points by which to measure treatment effectiveness. However, standard and widely applied methods for their measurement have not been applied to burn trauma victims. Therefore, the purpose of this study was to quantify these complications after burn trauma.
Patients with > or = 20% total body surface area burns admitted to a single center were prospectively enrolled. Standard sepsis criteria and multiple organ dysfunction (MOD) scores for the pulmonary, renal, cardiovascular, hepatic, and hematologic systems were determined. The incidence and risk factors for severe MOD (cumulative MOD score > or = 6) and severe sepsis were determined. The relationships between these complications and mortality and resource utilization were examined by univariate and multivariate analyses.
A total of 85 patients were enrolled over 1 year. Severe MOD developed in 24 (28%) and severe sepsis or septic shock developed in 12 (14%). Both were associated with increasing age and burn size and were more likely to occur in men. Most patients who developed severe MOD or severe sepsis survived (71% and 67%, respectively), and both were associated with longer intensive care unit stays and duration of mechanical ventilation.
According to simple and objective scoring systems, severe MOD and severe sepsis/septic shock are both related to burn size, age, and male sex. Both are related to intensive care unit length of stay and duration of mechanical ventilation.
在严重烧伤创伤后，器官功能障碍和脓毒症很常见，是机体对损伤的全身反应的可量化后果，可能是衡量治疗效果的重要终点。然而，用于测量这些情况的标准且广泛应用的方法尚未应用于烧伤创伤患者。因此，本研究的目的是量化烧伤创伤后的这些并发症。
前瞻性纳入一家单一中心收治的全身表面积烧伤≥20%的患者。确定标准脓毒症标准以及肺、肾、心血管、肝和血液系统的多器官功能障碍（MOD）评分。确定严重MOD（累积MOD评分≥6）和严重脓毒症的发生率及危险因素。通过单因素和多因素分析检查这些并发症与死亡率和资源利用之间的关系。
在1年多的时间里共纳入85例患者。24例（28%）发生严重MOD，12例（14%）发生严重脓毒症或脓毒性休克。两者均与年龄增长和烧伤面积增加相关，且在男性中更易发生。发生严重MOD或严重脓毒症的大多数患者存活（分别为71%和67%），且两者均与重症监护病房住院时间延长和机械通气时间延长相关。
根据简单客观的评分系统，严重MOD和严重脓毒症/脓毒性休克均与烧伤面积、年龄和男性性别有关。两者均与重症监护病房住院时间和机械通气时间有关。
