小儿中小面积烧伤创面脓毒症的诊治体会  

Experiences of diagnosis and treatment of medium and small area burns complicated with wound sepsis in children

作　　者：林国安 张荣厚 肖荣 林之琛 杨晓东 

机构地区：[1]解放军第一五九医院全军烧伤中心,河南驻马店463000

出　　处：《感染．炎症．修复》2015年第2期83-85,共3页Infection Inflammation Repair

摘　　要：目的：分析小儿中小面积烧伤创面脓毒症发生原因，总结小儿中小面积烧伤创面脓毒症诊治经验。方法：2006年8月-2012年11月我科共收治小儿中小面积烧伤并发创面脓毒症患者7例，年龄7个月～4岁，平均（1．52±1，17）岁。烧伤面积5％～14％TBSA，平均（11．57±3．26）％TBSA，其中，III度烧伤面积平均（9．86±4．02）％TBSA，均为热水烫伤。创面脓毒症出现时间为伤后7～21d，平均（13．0±5．o）d，其中1例为伤后即来院就诊，于伤后7d发生创面脓毒症，6例因在外院治疗出现脓毒症后转入我院。诊断确立后，立即应用碳青霉烯类强效抗生素，加强营养支持，纠正水、电解质紊乱等，在稳定或改善内环境之后，急诊手术切痂植皮。结果：本组7例中6例采用切痂植皮术，全部治愈。另1例未行切痂植皮术，于伤后10d死于多器官功能衰竭。结论：小儿中小面积烧伤并发创面脓毒症的高危年龄人群为4岁以内，一旦出现创面感染加深合并或不合并脓毒症早期表现者，应立即进行相关检查，积极综合治疗，尽早封闭创面。Objective： To analyze the causes, and to summarize the experience of diagnosis and treatment in children suffering from medium and small area burns （〈15% TBSA） complicated with wound sepsis. Methods： Seven children suffering from medium and small area burn complicated by wound sepsis were treated in our center from August 2006 to November 2012.The age ranged from 7 months to 4 years, with a mean age of （1.52~1.17） years. The area of burn injury ranged from 5% to 14%TBSA, with a mean of （11.57：t：3.26）% TBSA, and the mean area of III degree burn injury was （9.86＋4.02）%TBSA. All of them were injury by hot water, and the wound sepsis occurred on （13.0~5.0） postburn days （ranging from 7 to 21 days）. One of them was admitted to the hospital 3 hours after thermal injury, and the wound sepsis occurred 7 days post-burn. The other 6 cases were transferred to our hospital when the burn injury was complicated by wound sepsis. The treatment included the use of potent antibiotics such as Carbapenems, nutritional support, and correction of electrolyte derangement. Escharectomy and skin grafting were performed immediately after stabilization and improvement of the condition of the internal environment. Results： Six patients received escharectomy and skin grafting, and they were cured, while 1 died of multiple organ failure 10 days after burn injury. Conclusions： Children younger than 4 years old are populations of high risk when their medium and small area burns was complicated by wound sepsis, and once the invasive infection appeared in the burn wound, no matter whether early symptoms and signs of sepsis are present and not, corresponding examinations and treatments must be performed immediately.

关 键 词：儿童烧伤 中小面积创面脓毒症 高危人群 治疗 

分 类 号：R644[医药卫生—外科学]