Feng G Z
Department of Burn and Plastic surgery, Lan Zhou General Hospital of PLA.
Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi. 1992 Mar;8(1):13-5, 83-4.
36 cases with multiple organ failure (MOF) in a group of 178 severe burn injury patients during 1969-1989 were observed in our department. The rate of occurrence of MOF in this group was 20.2% (36/178). 25 cases out of these 36 patients died, and the mortality rate was 69.5% (25/36). In 10 cases 2 organs were involved, and two patients died; 3 organs were involved in 13 cases and nine of them died; more than 4 organs were affected in 13 cases and all of them died. The relationship between MOF and shock, inhalation injury as well as septicemia was discussed. Although there were many factors which could induce postburn multiple organ failure (PBMOF), the severity of the injury was the most fundamental inducing factor. The severer the burn injury, the higher the morbidity and mortality of PBMOF. Both shock and inhalation injury were important inducing factors in early PBMOF. Wound sepsis and septicemia were major inducing factors in delayed PBMOF. Majority of the delayed PBMOF took place during septicemia. In consideration of the high mortality of PBMOF and lack of effective treatment at present, it is extremely important to prevent severe burn injury patients from developing PBMOF. The measures to prevent PBMOF included: to correct shock adequately as soon as possible, to select the optimal time and appropriate extent of escharotomy and skin grafting, to try our best to ensure complete or near complete take of skin grafts, and to strengthen systemic metabolic support.
1969年至1989年期间,我科对178例重度烧伤患者中的36例多器官功能衰竭(MOF)患者进行了观察。该组MOF发生率为20.2%(36/178)。这36例患者中有25例死亡,死亡率为69.5%(25/36)。其中10例累及2个器官,2例死亡;13例累及3个器官,9例死亡;13例累及4个以上器官,全部死亡。讨论了MOF与休克、吸入性损伤及败血症之间的关系。虽然有许多因素可诱发烧伤后多器官功能衰竭(PBMOF),但损伤的严重程度是最根本的诱发因素。烧伤越严重,PBMOF的发病率和死亡率越高。休克和吸入性损伤都是早期PBMOF的重要诱发因素。创面脓毒症和败血症是延迟性PBMOF的主要诱发因素。大多数延迟性PBMOF发生在败血症期间。鉴于PBMOF的高死亡率以及目前缺乏有效的治疗方法,预防重度烧伤患者发生PBMOF极为重要。预防PBMOF的措施包括:尽快充分纠正休克,选择最佳时机和适当范围进行焦痂切开术和植皮术,尽力确保植皮完全或接近完全成活,并加强全身代谢支持。