Munster A M, Xiao G X, Guo Y, Wong L A, Winchurch R A
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Burn Care Rehabil. 1989 Jul-Aug;10(4):327-30. doi: 10.1097/00004630-198907000-00007.
A group of patients with severe burns were entered into two sequential prospective randomized trials for reduction of endotoxemia by the use of intravenous polymyxin B. The first group underwent polymyxin administration during the first week after burn injury in a bell-shaped dosage form constructed to resemble the level of endotoxemia as previously documented. This group showed a statistically highly significant reduction in endotoxin levels and a suggestive, but not statistically significant, reduction in wound infection and mortality in the treated group compared with controls. The second group of patients underwent treatment with perioperative polymyxin B given in conjunction with an excisional procedure of the burn wound. In this group, polymyxin B also accomplished a reduction in endotoxemia from preoperative to postoperative cases, but there was no significant reduction in clinical complication rate or mortality. In the dosages used, polymyxin B is nontoxic and promises to be a useful part of the surgeon's armamentarium in dealing with severe complications of gram-negative sepsis.
一组重度烧伤患者被纳入两项连续的前瞻性随机试验，以研究静脉注射多粘菌素B降低内毒素血症的效果。第一组患者在烧伤后的第一周接受多粘菌素治疗，采用钟形剂量形式，模拟先前记录的内毒素血症水平。与对照组相比，该组患者的内毒素水平在统计学上有高度显著降低，且治疗组的伤口感染和死亡率有下降趋势，但无统计学意义。第二组患者在烧伤创面切除手术围手术期接受多粘菌素B治疗。在这组患者中，多粘菌素B也使术前到术后的内毒素血症有所降低，但临床并发症发生率和死亡率并无显著降低。在所使用的剂量下，多粘菌素B无毒，有望成为外科医生应对革兰氏阴性菌败血症严重并发症的有用武器。
