抗感染督导疗法对烧伤脓毒症患者临床疗效的影响  

Effect of supervised anti-infection therapy on clinical outcomes of patients with burn sepsis

作　　者：吕涛[1] 刘冰[1] 赵孝开 娄季鹤[1] 李晓亮[1] 王磊[1] 李彦仓[1] 张建[1] 李树仁[1] 

机构地区：[1]郑州市第一人民医院烧伤科,河南郑州450004

出　　处：《中华医院感染学杂志》2018年第5期734-737,741,共5页Chinese Journal of Nosocomiology

摘　　要：目的探讨抗感染督导疗法对烧伤脓毒症患者临床结局的影响。方法选取医院2014年2月-2017年2月收治的烧伤脓毒症患者144例为研究对象,采用数字表法分为试验组和对照组,每组72例,对照组患者抗感染治疗依据临床常规抗感染治疗方法进行,试验组抗感染治疗依据《烧伤脓毒症抗感染督导疗法指导方针》进行,采集两组患者标本,检测病原菌,评价两组抗感染疗效和细菌清除率,记录两组抗菌药物使用时间、14d死亡率,治疗前后,采集患者静脉血,检测白介素2(IL-2)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)和C-反应蛋白(CRP)、可溶性肿瘤坏死因子受体I(sTNFR-I)和可溶性肿瘤坏死因子受体II(sTNFR-II)。结果试验组检出病原菌94株,其中革兰阴性菌49株,占52.13%,革兰阳性菌28株,占29.79%,真菌17株,占18.09%,对照组检出病原菌90株,其中革兰阴性菌45株,占50.00%,革兰阳性菌27株,占30.00%,真菌18株,占20.00%,两组病原菌构成差异无统计学意义;试验组细菌清除率、抗感染有效率均高于对照组(P<0.05),抗菌药物使用时间短于对照组(P<0.05),两组患者14d死亡率比较差异无统计学意义;治疗前,两组IL-2、IL-6、TNF-α、CRP、sTNFR-I和sTNFR-II水平差异均无统计学意义;治疗后,两组IL-2、IL-6、TNF-α、CRP、sTNFR-I均降低(P<0.05),且试验组低于对照组(P<0.05),sTNFR-II水平无变化。结论抗感染督导疗法可有效降低烧伤脓毒症患者炎性反应水平,提高抗感染疗效和细菌清除率,缩短抗菌药物使用时间,值得临床推荐。OBJECTIVE To explore the effect of supervised anti-infection therapy on clinical outcomes of patients with burn sepsis.METHODS A total of 144 patients with burn sepsis who were treated in the hospital from Feb2014 to Feb 2017 were recruited as the study subjects and randomly divided into the observation group and the control group,with 72 cases in each group.The control group was treated with anti-infection therapy based on the conventional anti-infection therapy,while the observation group was treated with anti-infection therapy based on the‘Suidelines of supervised an-infection therapy for burn sepsis’.The specimens that were collected from the two groups of patients were cultured for pathogens,the efficacy of anti-infection therapy and bacterial clearance rate were evaluated,the time of use of antibiotics and 14-day mortality rate were recorded,and the venous blood specimens were collected from the patients before and after the treatment so as to detect the levels of interleukin-2（IL-2）,interleukin-6（IL-6）and tumor necrosis factor-α（TNF-α）as well as C-reactive protein（CRP）,soluble tumor necrosis factor receptor I（sTNFR-I）and soluble tumor necrosis factor receptor II（sTNFR-II）.RESULTS Totally 94 strains of pathogens were isolated in the observation group,49（52.13%）of which were gram-negative bacteria,28（29.79%）were gram-positive bacteria,and 17（18.09%）were fungi.Totally 90 strains of pathogens were isolated in the control group,45（50.00%）of which were gram-negative bacteria,27（30.00%）were grampositive bacteria,and 18（20.00%）were fungi;there were no significant differences in the constituent ratios of pathogens between the two groups.The bacterial clearance rate and effective rate of anti-infection therapy were significantly higher in the observation group than in the control group（P〈0.05）,the time of use of antibiotics of the observation group was significantly shorter than that of the control group（P〈0.05）,and there was no significant difference

关 键 词：烧伤 脓毒症 结局 抗感染 督导 

分 类 号：R631.1[医药卫生—外科学]