Bang Rameshwar L, Sharma Prem N, Sanyal Suhas C, Al Najjadah Imad
Al-Babtain Centre for Plastic Surgery and Burns, Kuwait.
Burns. 2002 Dec;28(8):746-51. doi: 10.1016/s0305-4179(02)00183-3.
Seventy-nine (8.4%) patients during June 1992-May 1996 (Group-1) and 68 (7.2%) patients from June 1996 to May 2000 (Group-2) who developed septicaemia at the burns unit of Al-Babtain Centre for Plastic Surgery and Burns, Kuwait, were retrospectively studied and compared. The mean age of 26 years, male predominance, flame burns as main aetiology and mean burn percentage of >or=40% was observed in both the groups. Both groups revealed extensive flame burn, inhalation injury, intubation and difficult resuscitation as the risk factors. The proportion of satisfactory resuscitation increased significantly (P<0.001) in Group-2. The septicaemia commonly occurred within 2 weeks postburn but the number of episodes during 5 days postburn was less in Group-2. The surface wound was found to be the likely source of entry of the organisms into the blood stream in both the groups. The gram positive organisms were dominant aetiologic factor in both groups but an increase frequency of Acnetobacter was found in Group-2. The proportion of MRSE and Pseudomonas septicaemia was significantly higher (P<0.01) in the Group-1. The rate of survivors, in both the groups was higher among operated patients but it was significantly higher (P<0.001) in the Group-1. A mortality rate 20.6% in Group-2 decreased against Group-1, which can be attributed to better resuscitation, nutritional care, early detection of septicaemia, appropriate antibiotics and early wound excision and skin grafting. MOF was the cause of death of 60.9% in Group-1 and 85.7% in Group-2. There was no role of prophylactic antibiotic in burn patients in the incidence of septicaemia and mortality.
对1992年6月至1996年5月期间在科威特Al-Babtain整形外科和烧伤中心烧伤科发生败血症的79例（8.4%）患者（第1组）以及1996年6月至2000年5月期间的68例（7.2%）患者（第2组）进行了回顾性研究和比较。两组患者的平均年龄均为26岁，以男性为主，主要病因是火焰烧伤，平均烧伤面积≥40%。两组均显示广泛的火焰烧伤、吸入性损伤、插管和复苏困难是危险因素。第2组中满意复苏的比例显著增加（P<0.001）。败血症通常发生在烧伤后2周内，但第2组在烧伤后5天内的发作次数较少。在两组中，体表伤口均被认为是细菌进入血流的可能来源。革兰氏阳性菌是两组中的主要病因，但在第2组中发现不动杆菌的频率有所增加。第1组中耐甲氧西林表皮葡萄球菌和铜绿假单胞菌败血症的比例显著更高（P<0.01）。两组中接受手术治疗的患者存活率较高，但第1组显著更高（P<0.001）。第2组的死亡率为20.6%，低于第1组，这可归因于更好的复苏、营养护理、败血症的早期发现、适当的抗生素以及早期伤口切除和皮肤移植。多器官功能衰竭是第1组60.9%和第2组85.7%患者的死亡原因。预防性抗生素对烧伤患者败血症的发生率和死亡率没有影响。
