DOI: https://doi.org/10.22263/2312-4156.2017.4.48
Zhylinski Y.V.1,2
The complex method of medical sepsis prophylaxis in severely burnt patients
1Belarusian State Medical University, Minsk, Republic of Belarus
2Minsk City Clinical Emergency Hospital, Minsk, Republic of Belarus
Vestnik VGMU. 2017;16(4):48-57.
Abstract.
The hypermetabolic syndrome in severely burnt patients leads to secondary immunodeficiency, the decrease in wounds epithelialization, and translocation of microorganisms in the intestine, thereby contributing to the development of sepsis. Despite many approaches to the correction of hypermetabolism the goals of treatment remain unreached.
Objectives. To develop a method for the prevention of sepsis in a burn disease by correcting the hypermetabolic syndrome and to evaluate its efficacy.
Material and methods. A cohort study of severely burnt patients with a high probability of sepsis was conducted. The complex method of preventing sepsis by correcting the hypermetabolic syndrome of a burn disease included the temporary closure of wounds with the cadaveric skin, with the technique of preventing early rejection of an allograft, enteral feeding with the preparations of protected glutamine and β-blockers.
Results. The complex method of preventing sepsis 2,14 times (p<0,001) increased the lifetime of the skin allograft without rejection. The applied method 1,25 time (p<0,001) contributed to the increase of albumin, serum protein – 1,15 time (p=0,001) and IgG – 1,48 time (p=0,020), 1,26 time (p = 0,001) reduced the proportion of neutrophils, the value of C-reactive protein – 2,26 times (p=0,021) and the level of procalcitonin – 6,55 times (p=0,005). The use of the method of preventing early rejection of the skin allograft, enteral feeding with glutamine, β-blockers led to 1,97 time (p=0,004) decrease in the proportion of patients with sepsis, lethality – 2,17 times (p=0,044).
Conclusions. The complex method of preventing sepsis in case of a burn disease, including the prevention of early skin allograft rejection, enteral feeding with the preparations of protected glutamine, beta-blockers, resulted in 1,97-fold reduction in the proportion of patients with sepsis, and 1,31 time increased the effectiveness of treatment of severely burnt patients.
Key words: burn disease, sepsis, prophylaxis, skin alloplasty, enteral feeding, β-blockers.
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Information about authors:
Zhylinski Y.V. – surgeon of the burns department, Minsk City Clinical Emergency Hospital, post-graduate of the Chair of General Surgery, Belarusian State Medical University.
Correspondence address: Republic of Belarus, 220024, Minsk, 58 Kizhevatogo str., Minsk City Clinical Emergency Hospital. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Yauhen V. Zhylinski.
