基于Ryan评分评价烧伤严重程度与病原体感染创面-血液传播的关系

叶华 周孝亮 涂家金 徐泽华 汪显林

[摘要]目的 探讨基于Ryan评分评价烧伤严重程度与病原体感染创面-血液传播的关系，为烧伤患者合理系统性应用抗菌药提供依据。方法 回顾性分析我院2014年4月～2018年4月收治的230例严重烧伤患者的临床资料，基于Ryan评分将所有患者分为四组（0组、1组、2组、3组）进行描述性统计分析，以烧伤严重程度与病原体感染的创面-血液传播关系因素为自变量，烧伤严重程度为因变量，分析评价Ryan评分对创面-血液传播的影响，并基于Ryan评分分析血培养阳性患者创面培养阳性率。结果 四组患者的创面培养阳性率分别为15.7%、63.8%、82.5%及36.3%。严重烧伤患者创面培养菌群與血培养菌群一致，创面病原菌向血液传播与烧伤严重程度呈一定相关性（OR=0.124，95%CI=0.029～0.650），创面病原菌向血液传播为烧伤严重程度的相关因素。结论 Ryan评分可有效评价严重烧伤患者的烧伤严重程度与创面病原体向血液传播之间的关系。

[关键词]Ryan评分;烧伤严重程度;病原体感染;创面-血液传播;相关性

[中图分类号] R644          [文献标识码] A          [文章编号] 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

严重烧伤患者在烧伤之后机体会进入免疫抑制状态，从而会致使患者产生多种感染性的并发症，导致严重烧伤患者死亡的主要原因是感染性休克和多器官功能障碍[1]。有效地预防和控制感染可有效降低严重烧伤患者的死亡率，临床上对于有效预防和控制感染常选择敏感的抗生素作为烧伤严重程度的依据标准，但是临床怀疑脓毒血症暂无血培养，而发觉创面培养可为经验性选择抗生素提供了重要依据[2]。病原体从创面到血液的传播是否与烧伤严重程度存在一定关系国内外尚无研究。临床有研究曾显示，Ryan评分是基于3个危险因素（年龄>60岁、>40%的体表面积烧伤、吸入性损伤）预测烧伤患者死亡率的评分体系，当患者存在0、1、2或3个危险因素时，预测死亡率分别为0.3%、3.0%、33.0%或约90.0%[3]。本研究则基于Ryan评分评价烧伤严重程度与创面病原体向血液传播之间的关系进行探究，旨在为烧伤患者合理系统性应用抗菌药提供依据，现报道如下。