严重烧伤病人合并脓毒症时能量消耗的变化  

SEQUENTIAL CHANGES IN ENERGY EXPENDITURE IN SEVERELY BURNED PATIENTS WITH SEPSIS

作　　者：柴家科[1] 高建川[1] 郭振荣[1] 盛志勇[1] 贾晓明[1] 高维谊[1] 郝岱峰[1] 孙中生 

机构地区：[1]解放军第304医院

出　　处：《解放军医学杂志》1999年第2期88-90,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：对比研究了５６例烧伤脓毒症和非脓毒症病人能量消耗规律及可能机制。发现２２例烧伤脓毒症病人其烧伤总面积为（６８．７±１６．４）％、Ⅲ度面积为（２９．０±１８．６）％，较３４例烧伤非脓毒症病人其烧伤总面积为（５１．２±１４．８）％、Ⅲ度面积为（２４．５±１３．７）％者，能量消耗大（Ｐ＜０．０５）；脓毒症组病人静息能量消耗（ＲＥＥ）在整个观察期间也明显高于非脓毒症组，并且脓毒症病人在脓毒症期间ＲＥＥ较发生脓毒症前后高２０％～２５％（Ｐ＜０．０５），脓毒症组病人血浆ＩＬ－６、ＩＬ－８、ＴＮＦ、ＬＰＳ水平明显高于非脓毒症组。表明引起脓毒症的主要影响因素是烧伤总面积和Ⅲ度烧伤面积，脓毒症的发生进一步加重了烧伤后高代谢反应，其原因可能与多种炎症介质的过度释放有关。The purpose of this study was to investigate dynamic changes in various cytokines and resting energy expenditure (REE) in extensive burn patients with and without sepsis. Fifty six patients with over 30% total boday surface area (TBSA), in whom 22 cases being complicated with sepsis, were treated in our hospital from May, 1996 to December, 1997. REEs were monitored by means of Cardiorespiratory Diagnostic Systems ( Medical Graphics Corporation, USA) at patients' bedside. Plasma samples from 10 patients with sepsis and 8 patients without sepsis were assayed at intervals for LPS, TNF, IL 6, IL 8. Twenty two burn patients with sepsis had more extensive injury (68.7±16.4)% TBSA as compared with 34 burn patients without sepsis (51.2±14.8)% TBSA, P <0.05. The patients with sepsis showed higher levels of REE than those without sepsis throughout the observation, although an increase in REE was observed in all patients. Furthermore, the levels of REE in the stage of sepsis were 20%￣25% higher than that before or after the stage of sepsis ( P <0.05). Patients with sepsis had larger amounts of circulating LPS, TNF, IL 6, IL 8 than those without sepsis. These preliminary results suggest that the patients with more extensive burns are more vulnerable to sepsis. The episode of sepsis exaggerates hypermetabolic response of burn injury, and this may relate to an increased release of inflammatory mediators during sepsis.

关 键 词：烧伤 能量代谢 脓毒症 并发症 

分 类 号：R644.06[医药卫生—外科学] R631.1[医药卫生—临床医学]