Yao Yong-ming, Sheng Zhi-yong, Chai Jia-ke
Institute of Burn Research, the First Affiliated Hospital to the PLA General Hospital, Beijing 100037, P.R. China.
Zhonghua Shao Shang Za Zhi. 2008 Oct;24(5):337-9.
Sepsis and septic shock as a result of an invasive infection are challenging problems in extensively burned patients, and frequently end in multiple organ dysfunction syndrome (MODS). It is of great significance to further elucidate the pathogenetic mechanisms, and to seek novel intervention strategies to prevent and treat sepsis/MODS secondary to severe burns. A more complete understanding of the pathogenetic mechanisms of postburn sepsis would certainly elicit a number of potential therapeutic strategies for it. It is our belief that comprehensive clinical measures for management of severe sepsis should include rapid, adequate fluid resuscitation for burn shock, early feeding, effective control of infection, early escharectomy, and reinforcement of organ support. Once burn wound sepsis occurs, prompt removal of infected necrotic tissue is the key procedure to ensure a successful result. Further study is necessary to determine the precise mechanisms of these protective effects and the clinical advantages for postburn sepsis using evidence-based methodology system.
侵袭性感染导致的脓毒症和脓毒性休克是大面积烧伤患者面临的具有挑战性的问题,并且常常以多器官功能障碍综合征(MODS)告终。进一步阐明其发病机制,并寻求新的干预策略来预防和治疗严重烧伤继发的脓毒症/MODS具有重要意义。对烧伤后脓毒症发病机制的更全面理解肯定会引出许多针对它的潜在治疗策略。我们认为,严重脓毒症的综合临床管理措施应包括对烧伤休克进行快速、充分的液体复苏、早期喂养、有效控制感染、早期切痂以及加强器官支持。一旦发生烧伤创面脓毒症,及时清除感染坏死组织是确保取得成功结果的关键步骤。有必要进行进一步研究,以使用循证方法系统确定这些保护作用的确切机制以及对烧伤后脓毒症的临床益处。