Stuffer M, Semenitz E, Anderl H
Universitätsklinik für Plastische und Wiederherstellungschirurgie, Innsbruck.
Wien Klin Wochenschr. 1989 Mar 31;101(7):241-4.
60 to 70% of all late deaths in patients with severe burns are due to sepsis. Thus, treatment with antibiotics is essential in the overall management of such patients, which in our hospital is carried out according to the following principles: 1. No prophylactic antibiotic treatment. 2. Careful evaluation of the bacterial spectrum of the burns, nasopharyngeal area, anal region, sputum and blood cultures. 3. In case of bacteriaemia we start high-dose combination therapy with two different, specific chemotherapeutic agents, given alternately every 4 to 6 hours. 4. In concordance with the clinical picture antibiotic therapy is discontinued as soon as three subsequent blood cultures remain sterile. Since 1980, 58 patients with severe burns (extent: 20 to 90% of body surface) have been treated according to these principles. Mortality due to sepsis was low, namely 9.5% (2 out of 21 patients presenting with bacteriaemia), so that our method of treatment has proven to be effective.
严重烧伤患者所有晚期死亡病例中有60%至70%是由败血症所致。因此,抗生素治疗在这类患者的整体治疗中至关重要,在我们医院,抗生素治疗遵循以下原则:1. 不进行预防性抗生素治疗。2. 仔细评估烧伤创面、鼻咽部、肛门区域、痰液及血培养的细菌谱。3. 发生菌血症时,开始使用两种不同的特异性化疗药物进行大剂量联合治疗,每4至6小时交替给药。4. 当连续三次血培养结果均为无菌时,根据临床表现停止抗生素治疗。自1980年以来,58例严重烧伤患者(烧伤面积:体表面积的20%至90%)已按照这些原则接受治疗。败血症导致的死亡率较低,即9.5%(21例发生菌血症的患者中有2例死亡),因此我们的治疗方法已被证明是有效的。