烧伤创伤后脓毒症和器官功能障碍的危险因素及时间进程。
The risk factors and time course of sepsis and organ dysfunction after burn trauma.
作者信息
Fitzwater John, Purdue Gary F, Hunt John L, O'Keefe Grant E
机构信息
Department of Surgery, University of Texas Southwestern Medical Center at Dallas, USA.
出版信息
J Trauma. 2003 May;54(5):959-66. doi: 10.1097/01.TA.0000029382.26295.AB.
BACKGROUND
Sepsis and organ dysfunction are common and likely contribute to death after burn trauma. We sought to define relationships between sepsis, severe multiple organ dysfunction (MOD), and death after burn trauma.
METHODS
Adults with > or = 20% total body surface area burns were prospectively enrolled. Information regarding infection, severity of sepsis, and organ failure was collected daily. Risk factors (e.g., age, burn size, shock) were analyzed for their association with severe MOD, complicated sepsis, and death. We characterized the temporal relationship between organ failure and sepsis.
RESULTS
Of 175 patients, 27% developed severe MOD, 17% developed complicated sepsis, and 22% died. Full-thickness burn size, age, and inhalation injury were associated with MOD, sepsis, and death. Infection preceded MOD in 83% of patients with both. A base deficit of > or = 6 mEq/L at 24 hours after injury was associated with death.
CONCLUSION
When it occurs, severe MOD is usually preceded by infection. In addition, an elevated base deficit at 24 hours and septic shock are the most important factors associated with and possibly contributing to death after burn trauma.
背景
脓毒症和器官功能障碍很常见，可能导致烧伤创伤后的死亡。我们试图明确脓毒症、严重多器官功能障碍（MOD）与烧伤创伤后死亡之间的关系。
方法
前瞻性纳入全身表面积烧伤≥20%的成年人。每天收集有关感染、脓毒症严重程度和器官衰竭的信息。分析危险因素（如年龄、烧伤面积、休克）与严重MOD、复杂性脓毒症和死亡的关联。我们描述了器官衰竭与脓毒症之间的时间关系。
结果
175例患者中，27%发生严重MOD，17%发生复杂性脓毒症，22%死亡。全层烧伤面积、年龄和吸入性损伤与MOD、脓毒症和死亡相关。在同时发生两者的患者中，83%的患者感染先于MOD出现。伤后24小时碱剩余≥6 mEq/L与死亡相关。
结论
严重MOD发生时，通常先有感染。此外，伤后24小时碱剩余升高和感染性休克是与烧伤创伤后死亡相关且可能导致死亡的最重要因素。
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