Bang R L, Gang R K, Sanyal S C, Mokaddas E, Ebrahim M K
Al-Babtain Centre for Plastic Surgery and Burns, Ibn Sina Hospital, Kuwait.
Burns. 1998 Jun;24(4):354-61. doi: 10.1016/s0305-4179(98)00022-9.
Out of 943 patients treated from June 92 to May 96 at the burns unit of the Al-Babtain Centre for Plastic Surgery and Burns, Kuwait, 280 (30%) required admission to the burns intensive care unit (ICBU) and were studied retrospectively. Seventy-nine (28.2%) developed clinically and microbiologically proven septicaemia. Forty-four (56%) were males, 35 (44%) females with a mean age of 26 years (range 45 days to 75 years) and mean total body surface area burn (TBSA) of 46% (range 10-90%). Sixty-two had flame burns, 16 a scald and one had an electric burn. These 79 patients had a total of 118 septicaemic episodes. Sixty (76%) had only one and 19 (24%) had multiple episodes of septicaemia. Fifty-four (68%) had their first episode within 2weeks, though the maximum number of episodes was between 6 and 10 days postburn. Septicaemia was also observed in 13% of patients within 3 days postburn. Out of the 118 episodes, 48 were due to methicillin resistant Staphylococcus aureus (MRSA), 17 due to methicillin resistant Staphylococcus epidemidis (MRSE), 15 to Pseudomonas, 12 to Acinetobacter, four to Streptococcus, another four to Enterococci, two to Klebsiella, one due to Serratia and 15 to more than one organism. Once the septicaemia was diagnosed appropriate therapy was instituted. Fifty-six (71%) patients had 143 sessions of skin grafting and the mortality was low in operated patients. Twenty-three (29.1%) patients died. The low mortality rate was probably due to factors such as continuous clinical and microbiological surveillance leading to quick detection of aetiology, appropriate antibiotic therapy, care for nutrition and early wound cover. This study suggests that flame burn patients are more vulnerable to sepsis. Onset of septicaemia may be as early as 3 days and commonly within 2 weeks. A surface wound is the likely source of entry to the blood stream. Gram positive organisms are dominant in the aetiology. Early detection and appropriate treatment including wound coverage result in a better outcome.
1992年6月至1996年5月期间，科威特Al-Babtain整形外科与烧伤中心烧伤科共治疗了943例患者，其中280例（30%）需要入住烧伤重症监护病房（ICBU），并对其进行回顾性研究。79例（28.2%）发生了临床和微生物学证实的败血症。44例（56%）为男性，35例（44%）为女性，平均年龄26岁（范围为45天至75岁），平均烧伤总面积（TBSA）为46%（范围为10% - 90%）。62例为火焰烧伤，16例为烫伤，1例为电击伤。这79例患者共发生了118次败血症发作。60例（76%）仅有1次发作，19例（24%）有多次败血症发作。54例（68%）在2周内首次发作，不过发作次数最多的是在烧伤后6至10天。在烧伤后3天内，13%的患者也发生了败血症。在118次发作中，48次是由耐甲氧西林金黄色葡萄球菌（MRSA）引起，17次是由耐甲氧西林表皮葡萄球菌（MRSE）引起，15次是由铜绿假单胞菌引起，12次是由不动杆菌引起，4次是由链球菌引起，另外4次是由肠球菌引起，2次是由克雷伯菌引起，1次是由沙雷菌引起，15次是由多种微生物引起。一旦确诊败血症，即开始进行适当治疗。56例（71%）患者接受了143次皮肤移植手术，手术患者的死亡率较低。23例（29.1%）患者死亡。低死亡率可能归因于持续的临床和微生物学监测从而快速查明病因、适当的抗生素治疗、营养护理以及早期伤口覆盖等因素。本研究表明，火焰烧伤患者更容易发生败血症。败血症的发作可能早在3天，通常在2周内。体表伤口可能是细菌进入血流的来源。革兰氏阳性菌在病因中占主导地位。早期检测和包括伤口覆盖在内的适当治疗可带来更好的结果。
