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Средняя частота сепсиса у обожженных
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Средняя частота сепсиса у обожженных

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by admin10.12.2014
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Основываясь на тщательной дифференциальной диагностике сепсиса с учетом генерализации ожоговой инфекции, количественном определении микрофлоры и строгой оценке клиники, С. А. Полищук отмечает среднюю частоту сепсиса у обожженных 3,6-5,1% при летальности до 75%. По данным В. И. Кирсанова, из 382 больных с глубокими ожогами на площади более 5% поверхности тела сепсис развился у 24 больных, из которых 18 умерли.

По данным F. Muller, из 1250 больных с ожогами, несмотря на интенсивную терапию, летальность, связанная с ожоговым сепсисом, составила 35%.

Однако другие авторы отмечают определенный прогресс в лечении сепсиса. Поданным В. MacMillan, общая летальность в ожоговом центре г. Огайо снизилась с 15% в 1970 г. до 3-5% соответственно в 1975 и 1976 гг. Вместе с уменьшением обшей летальности упала и летальность от ожогового сепсиса — с 9% в 1970 г. до 1% в 1976 г. Снижение летальности зависело от проведения эффективных мер профилактики и борьбы с экзогенными источниками инфицирования, подавления ожоговой раневой инфекции, раннего распознавания сепсиса, обеспечения оптимального питания больных и, наконец, активного удаления некротического струпа. Ожоговая рана не всегда является основным источником инфекции при фатальной септицемии; при ожогах возможны и другие источники сепсиса: гнойный тромбофлебит, пневмония, септический бактериальный эндокардит и др.

Трудности диагностики ожогового сепсиса связаны с тем, что у ожоговых больных в первые 5-10 дней посевы крови, как правило, отрицательные. Большое значение для выявления этиологического агента при сепсисе имеет, по мнению R. Salisbury, биопсия ожоговой раны, а по данным R. Smith, лишь посмертное культивирование кардиальной крови и легочной ткани позволяет получить точную информацию в отношении инфекционного агента, явившегося причиной смерти обожженного. По данным этого автора, при культивировании крови ожоговых больных часто высевались стафилококки и синегнойная палочка, однако при посмертном культивировании кардиальной крови и легочной ткани причинным фактором, приведшим к летальному исходу, из 17 больных у 8 оказалась синегнойная палочка, у остальных 9 больных другие грамотрицательные бактерии или грибы. Таким образом, сепсис продолжает оставаться наиболее частым смертельным осложнением ожоговой травмы, поэтому проблема борьбы с ним остается весьма актуальной.

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