磺胺嘧啶鈰對(duì)燒傷膿毒癥的防治效果及燒傷膿毒癥早期診斷
發(fā)布時(shí)間：2018-05-04 16:30
本文選題：特重?zé)齻?/strong> + 磺胺嘧啶鈰�。� 參考：《南方醫(yī)科大學(xué)》2014年博士論文
【摘要】：研究背景 嚴(yán)重?zé)齻颊咭撞l(fā)膿毒癥。嚴(yán)重?zé)齻颊哂捎跈C(jī)體皮膚自然屏障不完整,同時(shí)治療中往往需建立人工氣道、多次經(jīng)創(chuàng)面置入深靜脈導(dǎo)管,且免疫功能受損。細(xì)菌易從創(chuàng)面、呼吸道、各種有創(chuàng)醫(yī)療管道等途徑侵入機(jī)體導(dǎo)致感染、全身炎癥反應(yīng)、膿毒癥“三部曲”,所以特重?zé)齻颊吣摱景Y發(fā)病率高達(dá)28%。 燒傷膿毒癥發(fā)病隱匿。86%的醫(yī)師認(rèn)為膿毒癥的癥狀不典型導(dǎo)致診斷及治療的延遲,而燒傷患者膿毒癥與非膿毒癥的癥狀和體征尤其不易鑒別,導(dǎo)致“燒傷膿毒癥”的診斷更具有隱匿性。 燒傷膿毒癥治療困難。嚴(yán)重?zé)齻颊咭坏┌l(fā)生膿毒癥后,因皮膚屏障短期內(nèi)無法重建而難以做到“病因治療”,很容易進(jìn)一步發(fā)展為嚴(yán)重膿毒癥、膿毒性休克甚至死亡,文獻(xiàn)報(bào)道燒傷膿毒癥發(fā)病后死亡率高達(dá)58.9%。 所以盡管已經(jīng)有眾多針對(duì)燒傷膿毒癥的預(yù)防手段如早期創(chuàng)面封閉、廣譜抗菌藥物應(yīng)用、外用抗菌藥物和敷料,以及膿毒癥治療的支持手段等,但對(duì)于燒傷膿毒癥的診治,仍是目前危重?zé)齻戎沃械碾y點(diǎn)。 目的和意義 鑒于燒傷膿毒癥發(fā)病率高、發(fā)病隱匿、死亡率高的臨床現(xiàn)實(shí),對(duì)于特重?zé)齻颊叩木戎?早期預(yù)防和早期診斷就尤其有意義。 外用抗菌藥物是燒傷創(chuàng)面處理的一個(gè)重要方法。燒傷學(xué)界共識(shí)燒傷后越早期應(yīng)用抗生素越可以有效預(yù)防感染,從早期創(chuàng)面處理開始就要外用抗菌藥物預(yù)防感染。并且對(duì)于大面積燒傷患者,其創(chuàng)面勢(shì)必長(zhǎng)期裸露缺少有效覆蓋,需要長(zhǎng)期外用抗菌藥物防治感染。所以對(duì)于傷后早期和部分全身情況不能耐受手術(shù)如休克糾正不佳、臟器功能不全者,或白體皮源奇缺不能提供足夠白體皮膚供移植的特重?zé)齻颊?其創(chuàng)面均需要應(yīng)用外用敷料或藥物(如經(jīng)典藥物磺胺嘧啶銀)暫時(shí)保護(hù),防治感染。 理想的燒傷創(chuàng)面外用藥應(yīng)該具有以下特點(diǎn)：1.可抑制燒傷毒素進(jìn)入機(jī)體：能有效去除或抑制燒傷毒素釋放入血。2.抗菌譜廣：能殺死或抑制各種病菌；3.穿透組織能力強(qiáng)：能殺死痂下致病菌,防止病菌進(jìn)入機(jī)體。4.作用周期長(zhǎng)：可適應(yīng)臨床工作需要,減輕臨床醫(yī)師工作量。5.副作用小。但目前臨床上應(yīng)用的各種消毒制劑、抗菌制劑等,均不能滿足以上要求。所以,尋求理想的創(chuàng)面外用藥物或敷料,始終是燒傷醫(yī)務(wù)工作者的探索目的。 文獻(xiàn)中報(bào)道鈰可以早期固定燒傷毒素,防止燒傷毒素入血損傷臟器[4]、減輕臟器水腫；可改善免疫功能[8];抗菌譜廣。國(guó)外已有臨床試驗(yàn)證實(shí)硝酸鈰能降低嚴(yán)重?zé)齻颊卟∷缆?同時(shí)國(guó)內(nèi)外均有動(dòng)物實(shí)驗(yàn)、臨床試驗(yàn)等證實(shí)燒傷創(chuàng)面外涂鈰劑具有和切痂等同的抗感染作用,但在國(guó)內(nèi)特重?zé)齻颊咧猩形匆姂?yīng)用。目前更多的研究證明硝酸鈰其實(shí)抗感染能力較磺胺嘧啶銀為差,但是鑭系金屬——鈰的多種作用,如固定燒傷毒素、免疫調(diào)理等,可能是降低嚴(yán)重?zé)齻颊卟∷缆实母驹颉?綜合以上文獻(xiàn)報(bào)道和查新結(jié)論,推測(cè)鈰劑為理想的燒傷創(chuàng)面外用藥,既可以早期保護(hù)創(chuàng)面,固定毒素,防治感染,同時(shí)可以調(diào)理免疫系統(tǒng),降低膿毒癥發(fā)病率。國(guó)內(nèi)現(xiàn)有上市消毒劑磺胺嘧啶鈰可能兼?zhèn)浠前粪奏さ目垢腥咀饔煤外嫷拿庖哒{(diào)理作用,推測(cè)其外用于燒傷創(chuàng)面可能具有防治燒傷膿毒癥的作用。 文獻(xiàn)報(bào)道81%的醫(yī)師期待清晰并且更容易被接受的膿毒癥臨床定義。如何早期識(shí)別高�；颊呒澳摱景Y的三個(gè)階段(膿毒癥、嚴(yán)重膿毒癥和膿毒性休克),提高膿毒癥診斷的敏感性,合理實(shí)施治療策略,準(zhǔn)確評(píng)估預(yù)后是目前面臨的難題。降鈣素原(PCT)近年廣受關(guān)注,可用于鑒別細(xì)菌感染導(dǎo)致的嚴(yán)重膿毒癥,并指導(dǎo)抗菌藥物的應(yīng)用,但在某些非感染情況如創(chuàng)傷、嚴(yán)重?zé)齻纫部赡軐?dǎo)致其升高,所以在特重?zé)齻戎芜^程中,如何評(píng)價(jià)PCT的應(yīng)用價(jià)值,依然需要進(jìn)一步探討。 鑒于以上原因,我們?cè)谔刂責(zé)齻颊呔戎沃幸牖前粪奏も嬐庥孟緞┖蚉CT檢測(cè),用來預(yù)防燒傷膿毒癥和早期診斷。 研究?jī)?nèi)容 1.評(píng)價(jià)磺胺嘧啶鈰對(duì)燒傷膿毒癥的預(yù)防作用。 為了證實(shí)以上設(shè)想,本研究對(duì)磺胺嘧啶鈰的體外、在體抑菌能力；對(duì)燒傷誘導(dǎo)的高血管通透性的影響；對(duì)嚴(yán)重?zé)齻笫笮菘似谒劳雎屎蜕鏁r(shí)間、感染期死亡率和生存時(shí)間的影響,進(jìn)行了系列研究。并將磺胺嘧啶鈰應(yīng)用于特重?zé)齻颊?通過觀察休克期補(bǔ)液量和休克期并發(fā)癥、創(chuàng)面感染率、血流感染率、膿毒癥發(fā)生率、臟器并發(fā)癥發(fā)生率、死亡率及SOFA評(píng)分等,評(píng)價(jià)磺胺嘧啶鈰對(duì)特重?zé)齻颊叩姆乐巫饔谩?2.探討特重?zé)齻颊吣摱景Y早期診斷策略和預(yù)后判斷。 本研究納入63例特重?zé)齻颊?通過在救治過程中將PCT和臨床指標(biāo)結(jié)合,探討特重?zé)齻摱景Y的早期診斷策略；探討PCT、燒傷危險(xiǎn)系數(shù)(Baux score)、體重指數(shù)(BMI)等因素,對(duì)特重?zé)齻颊哳A(yù)后的影響。 研究方法和過程 第一部分磺胺嘧啶鈰對(duì)燒傷誘導(dǎo)的高血管通透性影響。 1.磺胺嘧啶鈰降低燒傷大鼠血清對(duì)單層血管內(nèi)皮細(xì)胞電位變化影響：采用EVOM電壓電阻儀測(cè)定細(xì)胞跨膜電阻抗(TER)變化測(cè)定血管內(nèi)皮細(xì)胞間電位變化顯示,嚴(yán)重?zé)齻笫笱鍖?duì)血管內(nèi)皮細(xì)胞電位變化影響,高于假燒傷組(P=0.000)；磺胺嘧啶鈰外用于嚴(yán)重?zé)齻笫髣?chuàng)面后,燒傷大鼠血清對(duì)血管內(nèi)皮細(xì)胞電位變化影響,低于磺胺嘧啶銀組(P=0.000)。 2.磺胺嘧啶鈰沒有減輕燒傷后大鼠肺臟水腫：磺胺嘧啶鈰外用于嚴(yán)重?zé)齻笫髣?chuàng)面后,大鼠休克期肺臟器干濕重比與創(chuàng)面外用磺胺嘧啶銀組差異無統(tǒng)計(jì)學(xué)意義(P=0.05)。 3.磺胺嘧啶鈰沒有改善大鼠休克期血壓：磺胺嘧啶鈰外用于嚴(yán)重?zé)齻笫髣?chuàng)面后,傷后8小時(shí)內(nèi)其股動(dòng)脈有創(chuàng)血壓與磺胺嘧啶銀組無差異(P=0.05)。 第二部分磺胺嘧啶鈰對(duì)燒傷大鼠感染期的影響。 1.磺胺嘧啶鈰抑制體外細(xì)菌增殖：應(yīng)用抑菌環(huán)法測(cè)定磺胺嘧啶鈰對(duì)金黃色葡萄球菌、微生物的體外抑制作用,磺胺嘧啶鈰的抑菌環(huán)直徑與磺胺嘧啶銀的抑菌環(huán)直徑差異無統(tǒng)計(jì)學(xué)意義(P值均大于0.31)。 2.磺胺嘧啶鈰降低大鼠燒傷創(chuàng)面感染率：磺胺嘧啶鈰外用于大鼠中度燒傷創(chuàng)面后,創(chuàng)面感染率較與磺胺嘧啶銀組差異無統(tǒng)計(jì)學(xué)意義(P=0.789)。 3.磺胺嘧啶鈰延長(zhǎng)嚴(yán)重?zé)齻笫笊鏁r(shí)間：磺胺嘧啶鈰外用于嚴(yán)重?zé)齻笫?無補(bǔ)液)創(chuàng)面后,其72小時(shí)內(nèi)生存率與應(yīng)用磺胺嘧啶銀組無差異(P0.05),生存時(shí)間無差異(P0.05)；磺胺嘧啶鈰外用于嚴(yán)重?zé)齻笫?腹腔補(bǔ)液)創(chuàng)面后,其7d內(nèi)內(nèi)生存率與磺胺嘧啶銀組無差異(P0.05) 4.磺胺嘧啶鈰改善嚴(yán)重?zé)齻笫蠹?xì)胞免疫功能：磺胺嘧啶鈰外用于嚴(yán)重?zé)齻笫髣?chuàng)面后,其傷后7d的IL-6、IgG較磺胺嘧啶銀組高(P=0.04,P=0.044)。 第三部分磺胺嘧啶鈰對(duì)特重?zé)齻颊忒熜гu(píng)價(jià)。 1.治療組燒傷面積較對(duì)照組大,Baux score、休克指數(shù)較對(duì)照組高,吸入性損傷、復(fù)合傷、基礎(chǔ)疾病、入院時(shí)臟器功能比較均無差異。 2.磺胺嘧啶鈰對(duì)嚴(yán)重?zé)齻颊咝菘似谳斠毫坑绊懀夯前粪奏ゃy和磺胺嘧啶鈰聯(lián)合外用于燒傷創(chuàng)面,其休克期輸液量較單純應(yīng)用磺胺嘧啶銀組差異無統(tǒng)計(jì)學(xué)意義(P值大于0.108)。 3.磺胺嘧啶鈰對(duì)休克期并發(fā)癥發(fā)生率影響：磺胺嘧啶銀和磺胺嘧啶鈰聯(lián)合外用于燒傷創(chuàng)面,其并發(fā)癥發(fā)生率與單純應(yīng)用磺胺嘧啶銀組差異無統(tǒng)計(jì)學(xué)意義(P值均大于0.383)。 4.磺胺嘧啶鈰對(duì)嚴(yán)重?zé)齻颊吣摱景Y發(fā)病率影響：傷后0-7d聯(lián)用組膿毒癥發(fā)生率高于單純應(yīng)用磺胺嘧啶銀組,可能與原發(fā)傷情嚴(yán)重有關(guān)；但是8-35d兩組膿毒癥發(fā)病率差異無統(tǒng)計(jì)學(xué)意義(P值均大于0.189)。 5.磺胺嘧啶鈰對(duì)嚴(yán)重?zé)齻K器并發(fā)癥發(fā)生率影響：磺胺嘧啶銀和磺胺嘧啶鈰聯(lián)合外用于燒傷創(chuàng)面,其傷后3d、7d、14d、21d、28d與單純磺胺嘧啶銀組臟器并發(fā)癥發(fā)病率差異無統(tǒng)計(jì)學(xué)意義(P值均大于0.383))。 6.磺胺嘧啶鈰對(duì)特重?zé)齻摱景Y患者SOFA評(píng)分影響：磺胺嘧啶銀和磺胺嘧啶鈰聯(lián)合外用于燒傷創(chuàng)面,其傷后0、3d、7d、14d、21d、28d與單純磺胺嘧啶銀組SOFA評(píng)分差異無統(tǒng)計(jì)學(xué)意義(P值均大于0.209),但是傷后4-7日治療組SOFA評(píng)分大于11分者比例低于對(duì)照組(P=0.038)。 7.磺胺嘧啶鈰對(duì)特重?zé)齻颊吒腥酒趦?nèi)生存時(shí)間影響：以患者脫離感染期(創(chuàng)面面積小于5%TBSA)為截尾時(shí)間,發(fā)現(xiàn)磺胺嘧啶鈰組患者生存時(shí)間較磺胺嘧啶銀組長(zhǎng)(P=0.048),但生存率差異無統(tǒng)計(jì)學(xué)意義(P=0.446)。 第四部分特重?zé)齻颊邿齻摱景Y的早期診斷和危險(xiǎn)因素分析 1.PCT可早期診斷細(xì)菌感染導(dǎo)致的燒傷膿毒癥：用早期擬診斷和最終確診的策略,通過對(duì)89人次燒傷膿毒癥的發(fā)病診斷回顧確診,應(yīng)用Logistic回歸分析和ROC曲線法,分析792組PCT、WBC、CRP、PLT數(shù)據(jù)發(fā)現(xiàn),PCT和臨床體征結(jié)合可早期診斷燒傷膿毒癥,對(duì)于嚴(yán)重?zé)齻颊?PCT值達(dá)到1.035或24h內(nèi)PCT升至原基礎(chǔ)值1倍以上,需調(diào)整治療措施。 2. Baux score、BMI、PCT值可預(yù)測(cè)嚴(yán)重?zé)齻缙陬A(yù)后：通過分析63例成人特重?zé)齻戎芜^程和預(yù)后,結(jié)合Baux score、BMI、PCT值等指標(biāo),用COX分析統(tǒng)計(jì)方法,發(fā)現(xiàn)Baux score、BMI、PCT48h/PCT24h高,死亡可能性越大。 綜上所述,磺胺嘧啶鈰改善燒傷誘導(dǎo)血管高通透性,可降低嚴(yán)重?zé)齻颊吒腥酒趦?nèi)死亡率,提示燒傷創(chuàng)面應(yīng)用磺胺嘧啶鈰是治療嚴(yán)重?zé)齻挠行Х椒ǎ籔CT和臨床體征結(jié)合可提前早期診斷膿毒癥；PCT值越高,死亡可能性越大。 結(jié)論 1.磺胺嘧啶鈰可改善嚴(yán)重?zé)齻逭T導(dǎo)的血管內(nèi)皮細(xì)胞高通透性。 2.磺胺嘧啶鈰具有和磺胺嘧啶銀近似的抑菌能力,并且可以改善嚴(yán)重?zé)齻麑?dǎo)致的免疫功能異常。 3.磺胺嘧啶鈰能延長(zhǎng)嚴(yán)重?zé)齻笫?無補(bǔ)液)72小時(shí)內(nèi)生存時(shí)間和嚴(yán)重?zé)齻笫?補(bǔ)液)14d內(nèi)生存時(shí)間；磺胺嘧啶鈰結(jié)合磺胺嘧啶銀能降低特重?zé)齻颊吒腥酒赟OFA評(píng)分,延長(zhǎng)特重?zé)齻颊呱鏁r(shí)間。 4.PCT結(jié)合臨床體征可早期診斷細(xì)菌感染導(dǎo)致的燒傷膿毒癥,24h內(nèi)PCT如果升至原基礎(chǔ)值1倍以上或達(dá)至1.035ng/ml,需調(diào)整抗感染治療措施。 5. Baux score、BMI、傷后48小時(shí)內(nèi)PCT值越高,特重?zé)齻颊咚劳隹赡苄栽酱蟆?br/>[Abstract]:Research background
Patients with severe burns are prone to sepsis. Patients with severe burns are not complete because of the natural skin barrier of the body. At the same time, artificial airway is often set up in the treatment, and the deep venous catheter is inserted through the wound many times, and the immune function is damaged. The bacteria are easily invaded from the wound, respiratory tract, and various invasive medical pipes and other ways to cause infection and systemic inflammation. Should be sepsis trilogy, so the incidence of sepsis in severely burned patients is as high as 28%.
The physicians of the occult.86% in the onset of burn sepsis believe that the symptoms and signs of sepsis and non sepsis are especially difficult to differentiate between the symptoms and symptoms of sepsis, and the diagnosis of "burn sepsis" is more occult.
It is difficult to treat severe burn sepsis. Once the sepsis occurs in severe burn patients, it is difficult to achieve "etiological treatment" because the skin barrier can not be rebuilt in the short term. It is easy to further develop into severe sepsis, septic shock and even death. The mortality rate of sepsis after burn is up to 58.9%.
Therefore, there are many preventive measures for burn sepsis, such as early wound closure, broad spectrum antibiotic use, external use of antibiotics and dressings, and support for the treatment of sepsis, but the diagnosis and treatment of burn sepsis is still a difficult point in the treatment of critical burn.
Purpose and significance
In the light of the clinical reality of high incidence of burn sepsis, concealment and high mortality, early prevention and early diagnosis of severe burn patients is of particular significance.
The external use of antibiotics is an important method for the treatment of burn wounds. It is common understanding that the more early application of antibiotics is the more effective prevention of infection, and the use of antibiotics to prevent infection from the early wound treatment. It is necessary to apply external dressings or drugs (such as the classic drug sulfadiazine silver) for the early and partial general conditions after the injury, such as the poor correction of the shock, the dysfunction of the organs, or the deficiency of the white body skin source that can not provide sufficient white body skin for the special burn patients. Time protection, prevention and treatment of infection.
Ideal burn wound medication should have the following characteristics: 1. can inhibit burn toxin into the body: can effectively remove or inhibit the release of burn toxin into the blood.2. antibacterial spectrum: can kill or inhibit various pathogens; 3. penetrating tissue ability is strong: can kill the eschar pathogenic bacteria, prevent germs into the body.4. long period of action: can adapt to the body The clinical work needs to reduce the side effect of the clinician's workload.5., but the clinical application of various disinfection preparations, antibacterial agents, etc., can not meet the above requirements. Therefore, the search for the ideal external use of drugs or dressings is always the goal of the burn medical workers.
It is reported that cerium can fix the burn toxin in early stage, prevent the burn toxin into the blood damage organ [4], reduce the organ edema, improve the immune function [8], and have a wide spectrum of antimicrobial spectrum. The clinical trials abroad have confirmed that cerium nitrate can reduce the mortality of severely burned patients, and both domestic and foreign animal experiments and clinical trials confirm the burn wound coating. Cerium has the same anti infection effect as eschar, but it has not been used in the severe burn patients in China. At present, more studies have shown that cerium nitrate is in fact less resistant to infection than sulfadiazine, but the various roles of lanthanide metal, such as fixed burn toxin and immunization, may reduce the death of severely burned patients. The root cause of the rate.
According to the above literature and the new conclusions, it is conjectured that cerium is an ideal drug for the burn wound. It can protect the wound, fix the toxin, prevent the infection, and regulate the immune system and reduce the incidence of sepsis. The current listed disinfectant, sulfadiazine, can also protect the anti infection effect of sulfadiazine and the immune modulation of cerium. It is presumed that it may be used to treat burn sepsis.
81% of the doctors in the literature are looking forward to a clear and more acceptable clinical definition of sepsis. How to identify early high-risk patients and three stages of sepsis (sepsis, severe sepsis and septic shock), improve the sensitivity of the diagnosis of sepsis, the rational implementation of the treatment strategy, and the accurate assessment of the prognosis is a difficult problem. Calcitonin PCT has been widely concerned in recent years. It can be used to identify the severe sepsis caused by bacterial infection and to guide the application of antibiotics. However, in some non infection cases such as trauma and severe burns, it may also lead to its rise. So it is still necessary to discuss how to evaluate the application value of PCT during the treatment of special severe burns.
In view of the above reasons, we introduced the sulfadiazine cerium external disinfectant and PCT in the treatment of severe burn patients to prevent burn sepsis and early diagnosis.
research contents
1. to evaluate the preventive effect of sulfadiazine Cerium on burn sepsis.
In order to confirm the above idea, the effect of sulfadiazine Cerium on the body bacteriostasis in vitro, the effect of the high vascular permeability induced by burn, the mortality and survival time, the mortality and the survival time of the severely burned rats in the shock period were studied. The effect of sulfadiazine on the treatment of severe burn patients was evaluated by observing the volume of fluid infusion and shock stage complications, the rate of wound infection, the rate of blood flow infection, the incidence of sepsis, the incidence of organ complications, the mortality and SOFA score.
2. to explore the early diagnosis strategy and prognosis of sepsis in severely burned patients.
In this study, 63 patients with severe burn were combined to explore the early diagnosis strategy of severe burn sepsis by combining PCT with clinical indicators in the treatment process, and to explore the influence of PCT, Baux score, body mass index (BMI) and other factors on the prognosis of severe burn patients.
Research methods and processes
The first part is the effect of sulfadiazine Cerium on burn induced high vascular permeability.
The effect of 1. sulfadiazine Cerium on the changes of the potential of the monolayer vascular endothelial cells was reduced by the serum of the burned rats. The changes in the intercellular electrical potential of the vascular endothelial cells were measured by the EVOM voltage resistor (TER), and the effect of the serum on the changes of the vascular endothelial cell potential in severely burned rats was higher than that of the false burn group (P=0.000); The effect of pyrimidine Cerium on the potential changes of vascular endothelial cells in burn rats after burn wounds was lower than that in sulfadiazine group (P=0.000).
2. sulfadiazine cerium did not alleviate the pulmonary edema in rats after burn: after the use of sulfadiazine cerium in the wound of severely burned rats, there was no significant difference between the dry and wet weight ratio of the lung organs in the shock stage of the rats and the sulfadiazine silver group outside the wound (P=0.05).
3. sulfadiazine cerium did not improve the blood pressure in the shock stage of rats. After the use of sulfadiazine cerium in the wound of severely burned rats, there was no difference in the blood pressure between the femoral artery and the sulfadiazine group within 8 hours after injury (P=0.05).
The second part is the influence of sulfadiazine Cerium on the infection period of burn rats.
1. sulfadiazine cerium inhibited the proliferation of bacteria in vitro: the inhibitory effect of sulfadiazine Cerium on Staphylococcus aureus, microorganism, the diameter of sulfadiazine cerium and the diameter of bacteriostasis ring of sulfadiazine silver were not statistically significant (P value was greater than 0.31).
2. sulfadiazine cerium reduced the infection rate of burn wound in rats: the infection rate of the wound was no significant difference compared with the sulfadiazine group (P=0.789) after the sulfadiazine cerium was used in the rats with moderate burn wounds.
3. sulfadiazine cerium prolongs the survival time of severely burned rats: there is no difference in survival rate within 72 hours (P0.05) and no difference (P0.05) in the survival time of sulfadiazine (sulfadiazine) after burn wounds in severely burned rats (P0.05), and the internal birth of sulfadiazine after external use in the wound of severely burned rats (peritoneal fluid) There was no difference between the survival rate and the group of silver sulfadiazine (P0.05)
4. sulfadiazine cerium improves the cellular immune function of severely burned rats: after the use of sulfadiazine cerium in severely burned rats, the IL-6 and IgG of the injured rats are higher than those of the sulfadiazine silver group (P=0.04, P=0.044).
The third part is the evaluation of the efficacy of sulfadiazine cerium in severely burned patients.
In 1. treatment group, the area of burn was larger than that of the control group, Baux score, the shock index was higher than the control group, inhalation injury, compound injury, basic disease, and no difference in organ function at admission.
The effect of 2. sulfadiazine on the volume of transfusion during shock period in severely burned patients: the combination of sulfadiazine silver and sulfadiazine cerium in the burn wound, and there is no significant difference in the volume of transfusion in shock period compared with that of the only group of sulfadiazine silver (P value is more than 0.108).
3. the effect of sulfadiazine Cerium on the incidence of complications in shock stage: the combination of sulfadiazine silver and sulfadiazine was used in burn wounds, and the incidence of complications was not statistically significant (P value was more than 0.383) with the only group of sulfadiazine silver group.
The effect of 4. sulfadiazine on the incidence of sepsis in severely burned patients: the incidence of sepsis in the 0-7d group after injury was higher than that in the only group of sulfadiazine silver group, which may be related to the severity of the primary injury, but there was no significant difference in the incidence of sepsis in the two groups (P value was greater than 0.189).
The effect of 5. sulfadiazine on the incidence of severe burn viscera complications: the combination of sulfadiazine silver and sulfadiazine cerium in the burn wound, the incidence of 3D, 7d, 14d, 21d, 28d and simple sulfadiazine group after injury was not statistically significant (P value was greater than 0.383).
The effect of 6. sulfadiazine on the SOFA score of patients with severe burn sepsis: the combination of sulfadiazine silver and sulfadiazine cerium for burn wounds, and there was no statistical difference between the SOFA scores of 0,3d, 7d, 14d, 21d, 28d and pure sulfadiazine group after the injury (P values were both greater than 0.209), but the proportion of SOFA scores in the treatment group was lower than 11 in 4-7 days after injury. In the control group (P=0.038).
The effect of 7. sulfadiazine on the survival time during the infection period of the patients with severe burn: the time of closure of the patients (less than 5%TBSA of the wound area) was taken as the truncation time, and the survival time of the sulfadiazine group was more than that of the sulfadiazine silver group (P=0.048), but the difference of survival rate was not statistically significant (P=0.446).
The fourth part of early diagnosis and risk factors analysis of burn sepsis in severely burned patients
1.PCT can be used for early diagnosis of bacterial infection caused by burn sepsis: the early diagnostic and final diagnosis strategy, retrospective diagnosis of 89 patients with burn sepsis, Logistic regression analysis and ROC curve method, and 792 groups of PCT, WBC, CRP, PLT data, and the combination of PCT and clinical signs can be used for early diagnosis of burn sepsis. For severely burned patients, the PCT value reaches 1.035 or the 24h PCT rises to more than 1 times the original base value, so the treatment measures need to be adjusted.
2. Baux score, BMI, and PCT values can predict the early prognosis of severe burns: by analyzing the treatment process and prognosis of 63 cases of adult severe burns, combined with the Baux score, BMI, PCT value and so on, the COX analysis statistics show that Baux score, BMI, higher, the greater the possibility of death.
In summary, sulfadiazine cerium can improve the permeability of the blood vessels induced by burn and reduce the mortality of severe burn patients during the infection period. It suggests that the application of sulfadiazine to burn wounds is an effective method for the treatment of severe burns; the combination of PCT and clinical signs can early diagnose sepsis; the higher the PCT value, the greater the possibility of death.
conclusion
1. sulfadiazine cerium can improve the permeability of vascular endothelial cells induced by severe burn serum.
2. sulfadiazine cerium has the similar bacteriostatic ability with silver sulfadiazine, and can improve the immune function abnormality caused by severe burn.
3. sulfadiazine cerium can prolong severely burned rats.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R644
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