基于Ryan評分評價燒傷嚴重程度與病原體感染創面-血液傳播的關系

葉華 周孝亮 涂家金 徐澤華 汪顯林

[摘要]目的 探討基于Ryan評分評價燒傷嚴重程度與病原體感染創面-血液傳播的關系，為燒傷患者合理系統性應用抗菌藥提供依據。方法 回顧性分析我院2014年4月～2018年4月收治的230例嚴重燒傷患者的臨床資料，基于Ryan評分將所有患者分為四組（0組、1組、2組、3組）進行描述性統計分析，以燒傷嚴重程度與病原體感染的創面-血液傳播關系因素為自變量，燒傷嚴重程度為因變量，分析評價Ryan評分對創面-血液傳播的影響，并基于Ryan評分分析血培養陽性患者創面培養陽性率。結果 四組患者的創面培養陽性率分別為15.7%、63.8%、82.5%及36.3%。嚴重燒傷患者創面培養菌群與血培養菌群一致，創面病原菌向血液傳播與燒傷嚴重程度呈一定相關性（OR=0.124，95%CI=0.029～0.650），創面病原菌向血液傳播為燒傷嚴重程度的相關因素。結論 Ryan評分可有效評價嚴重燒傷患者的燒傷嚴重程度與創面病原體向血液傳播之間的關系。

[關鍵詞]Ryan評分;燒傷嚴重程度;病原體感染;創面-血液傳播;相關性

[中圖分類號] R644? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 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

嚴重燒傷患者在燒傷之后機體會進入免疫抑制狀態，從而會致使患者產生多種感染性的并發癥，導致嚴重燒傷患者死亡的主要原因是感染性休克和多器官功能障礙[1]。有效地預防和控制感染可有效降低嚴重燒傷患者的死亡率，臨床上對于有效預防和控制感染常選擇敏感的抗生素作為燒傷嚴重程度的依據標準，但是臨床懷疑膿毒血癥暫無血培養，而發覺創面培養可為經驗性選擇抗生素提供了重要依據[2]。病原體從創面到血液的傳播是否與燒傷嚴重程度存在一定關系國內外尚無研究。臨床有研究曾顯示，Ryan評分是基于3個危險因素（年齡>60歲、>40%的體表面積燒傷、吸入性損傷）預測燒傷患者死亡率的評分體系，當患者存在0、1、2或3個危險因素時，預測死亡率分別為0.3%、3.0%、33.0%或約90.0%[3]。本研究則基于Ryan評分評價燒傷嚴重程度與創面病原體向血液傳播之間的關系進行探究，旨在為燒傷患者合理系統性應用抗菌藥提供依據，現報道如下。