基于Ryan評(píng)分評(píng)價(jià)燒傷嚴(yán)重程度與病原體感染創(chuàng)面-血液傳播的關(guān)系

葉華 周孝亮 涂家金 徐澤華 汪顯林

[摘要]目的 探討基于Ryan評(píng)分評(píng)價(jià)燒傷嚴(yán)重程度與病原體感染創(chuàng)面-血液傳播的關(guān)系，為燒傷患者合理系統(tǒng)性應(yīng)用抗菌藥提供依據(jù)。方法 回顧性分析我院2014年4月～2018年4月收治的230例嚴(yán)重?zé)齻颊叩呐R床資料，基于Ryan評(píng)分將所有患者分為四組（0組、1組、2組、3組）進(jìn)行描述性統(tǒng)計(jì)分析，以燒傷嚴(yán)重程度與病原體感染的創(chuàng)面-血液傳播關(guān)系因素為自變量，燒傷嚴(yán)重程度為因變量，分析評(píng)價(jià)Ryan評(píng)分對(duì)創(chuàng)面-血液傳播的影響，并基于Ryan評(píng)分分析血培養(yǎng)陽(yáng)性患者創(chuàng)面培養(yǎng)陽(yáng)性率。結(jié)果 四組患者的創(chuàng)面培養(yǎng)陽(yáng)性率分別為15.7%、63.8%、82.5%及36.3%。嚴(yán)重?zé)齻颊邉?chuàng)面培養(yǎng)菌群與血培養(yǎng)菌群一致，創(chuàng)面病原菌向血液傳播與燒傷嚴(yán)重程度呈一定相關(guān)性（OR=0.124，95%CI=0.029～0.650），創(chuàng)面病原菌向血液傳播為燒傷嚴(yán)重程度的相關(guān)因素。結(jié)論 Ryan評(píng)分可有效評(píng)價(jià)嚴(yán)重?zé)齻颊叩臒齻麌?yán)重程度與創(chuàng)面病原體向血液傳播之間的關(guān)系。

[關(guān)鍵詞]Ryan評(píng)分;燒傷嚴(yán)重程度;病原體感染;創(chuàng)面-血液傳播;相關(guān)性

[中圖分類號(hào)] R644? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1674-4721（2019）2（c）-0042-03

[Abstract] Objective To explore the relationship between severity of burn and pathogen infection wound-blood transmission evaluated based on Ryan score， and to provide evidence for rational and systematic application of antibiotics in burn patients. Methods A retrospective analysis was made of 230 severely burned patients admitted to our hospital from April 2014 to April 2018. All patients were divided into four groups （0， 1， 2， 3 groups） according to Ryan score for descriptive statistical analysis. The relationship between severity of burn and wound-blood transmission of pathogen infection was independent variable and severity of burn was dependent variable. The influence of Ryan score on wound-blood transmission was analyzed and evaluated. The positive rate of wound culture in patients with positive blood culture was analyzed based on Ryan score. Results The positive rate of wound culture in the four positive blood-borne groups were 15.7%， 63.8%， 82.5% and 36.3%. The bacterial flora of wound culture was consistent with that of blood culture in severely burned patients. There was a certain correlation between the blood-borne pathogenic bacteria and the severity of burn （OR=0.124， 95%CI=0.029-0.650）. The blood-borne transmission of pathogenic bacteria in wounds was a correlative factor of severity of burn. Conclusion Ryan score can effectively evaluate the relationship between the severity of burn and the spread of pathogens to blood in severely burned patients.

[Key words] Ryan score; Burn severity; Pathogen infection; Wound blood transmission; Correlation

嚴(yán)重?zé)齻颊咴跓齻髾C(jī)體會(huì)進(jìn)入免疫抑制狀態(tài)，從而會(huì)致使患者產(chǎn)生多種感染性的并發(fā)癥，導(dǎo)致嚴(yán)重?zé)齻颊咚劳龅闹饕蚴歉腥拘孕菘撕投嗥鞴俟δ苷系K[1]。有效地預(yù)防和控制感染可有效降低嚴(yán)重?zé)齻颊叩乃劳雎?，臨床上對(duì)于有效預(yù)防和控制感染常選擇敏感的抗生素作為燒傷嚴(yán)重程度的依據(jù)標(biāo)準(zhǔn)，但是臨床懷疑膿毒血癥暫無(wú)血培養(yǎng)，而發(fā)覺(jué)創(chuàng)面培養(yǎng)可為經(jīng)驗(yàn)性選擇抗生素提供了重要依據(jù)[2]。病原體從創(chuàng)面到血液的傳播是否與燒傷嚴(yán)重程度存在一定關(guān)系國(guó)內(nèi)外尚無(wú)研究。臨床有研究曾顯示，Ryan評(píng)分是基于3個(gè)危險(xiǎn)因素（年齡>60歲、>40%的體表面積燒傷、吸入性損傷）預(yù)測(cè)燒傷患者死亡率的評(píng)分體系，當(dāng)患者存在0、1、2或3個(gè)危險(xiǎn)因素時(shí)，預(yù)測(cè)死亡率分別為0.3%、3.0%、33.0%或約90.0%[3]。本研究則基于Ryan評(píng)分評(píng)價(jià)燒傷嚴(yán)重程度與創(chuàng)面病原體向血液傳播之間的關(guān)系進(jìn)行探究，旨在為燒傷患者合理系統(tǒng)性應(yīng)用抗菌藥提供依據(jù)，現(xiàn)報(bào)道如下。