严重烧伤并发耐碳青霉烯类肺炎克雷伯杆菌脓毒症的救治体会  

Treatment experience of severe burn complicated with carbapenem-resistant Klebsiella pneumoniae sepsis

作　　者：王磊[1] 李晓亮[1] 娄季鹤[1] 李延仓[1] 赵孝开 张建[1] 李琰光 WANG Lei;LI Xiao-liang;LOU Ji-he;LI Yan-cang;ZHAO Xiao-kai;ZHANG Jian;LI Yan-guang(Burn Department,Zhengzhou the First People’s Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州市第一人民医院烧伤科,郑州450000

出　　处：《医药论坛杂志》2022年第11期33-36,共4页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20200700)。

摘　　要：目的总结25例严重烧伤并发耐碳青霉烯类肺炎克雷伯杆菌(carbapenem-resistant klebsiella pneumoniae,CRKP)脓毒症的救治经验,进一步提高对严重烧伤并发CRKP脓毒症的救治水平。方法回顾性分析郑州市第一人民医院烧伤科2017年10月至2019年6月所收治的烧伤面积>50%TBSA的大面积严重烧伤救治过程中并发CRKP脓毒症的患者25例,对创面处理、感染控制、脏器保护、免疫调理及营养支持等进行总结。结果25例患者经积极创面处理,早期进行切削痂植皮手术封闭创面;早期、足量、联合应用敏感抗生素;应用脏器保护药物,积极保肝、护肾、营养心肌,对出现急性肾功能衰竭的病例及时进行肾脏替代治疗;对出现免疫抑制的病例及时应用免疫调理药物治疗并逐步增加肠内营养支持治疗的23例患者成活,未进行上述治疗的2例患者死亡。结论对于严重烧伤并发耐碳青霉烯类肺炎克雷伯杆菌脓毒症的救治,尽早去除感染源、封闭创面,合理选择抗生素,保护脏器功能,免疫调理以及营养支持等综合治疗可提高治愈率。Objective To summarize the treatment experience of 25 cases of severe burn complicated with carbapenem-resistant Klebsiella pneumoniae(CRKP)sepsis,and to further improve the treatment level of severe burn complicated with CRKP sepsis.Methods A retrospective analysis was performed on 25 patients with CRKP sepsis during the treatment of large area severe burns with burn area>50%TBSA admitted to the Burn Department of Zhengzhou First People’s Hospital from October 2017 to June 2019,and wound management,infection control,organ protection,immune conditioning and nutritional support were summarized.Results Twenty-five patients underwent scab cutting and skin grafting to seal the wound after active wound treatment.Early,sufficient and combined use of sensitive antibiotics;The use of organ protection drugs,actively protect the liver,protect the kidney,nourish the myocardium,the occurrence of acute renal failure cases of kidney replacement therapy;23 patients with immunosuppression who were treated with immunoconditioning drugs and gradually increased enteral nutritional support survived,and 2 patients who did not receive such treatment died.Conclusion For the treatment of severe burn complicated with carbapenem-resistant Klebsiella pneumoniae sepsis,the comprehensive treatment including early removal of infection source,wound sealing,rational selection of antibiotics,protection of organ function,immune conditioning and nutritional support can improve the cure rate.

关 键 词：严重烧伤 耐碳青霉烯类肺炎克雷伯杆菌 脓毒症 临床治疗 

分 类 号：R631[医药卫生—外科学]