중증 화상 환자의 조기 가피절제술에 대한 연구
The Early Escharectomy in Massive Burns
고상훈, 김도헌, 허준, 이재정, 이규만, 허미나, 김종현, 박성길, 전성은, 윤대근, 강희준, 전욱,
소속 상세정보
고상훈 ( Ko Sang-Hoon )
한림대학교 의과대학 한강성심병원 외과
김도헌 ( Kim Do-Hern )
한림대학교 의과대학 한강성심병원 외과학교실
허준 ( Hur Jun )
한림대학교 의과대학 한강성심병원 외과학교실
이재정 ( Lee Jae-Jung )
한림대학교 의과대학 한강성심병원 외과
이규만 ( Lee Kyu-Man )
한림대학교 의과대학 한강성심병원 진단검사의학과
허미나 ( Hur Mi-Na )
한림대학교 의과대학 한강성심병원 진단검사의학과
김종현 ( Kim Jong-Hyun )
한림대학교 의과대학 한강성심병원 외과학교실
박성길 ( Park Sung-Gil )
한림대학교 의과대학 한강성심병원 외과학교실
전성은 ( Chon Sung-Eun )
한림대학교 의과대학 한강성심병원 외과
윤대근 ( Yoon Dae-Kun )
한림대학교 의과대학 한강성심병원 외과
강희준 ( Kang Hee-Jun )
한림대학교 의과대학 한강성심병원 외과
전욱 ( Chun Wook )
한림대학교 의과대학 한강성심병원 외과학교실
KMID : 0371320040670040308
Abstract
PURPOSE: Burn wound infection, sepsis and organ failure have been major causes of death in massive burn patient. Because it is difficult to fundamentally prevent bacterial colonization by medical treatment, the need of surgical intervention is advocated by many authors. Therefore the effects of early excision and optimal time were studied.
METHODS: Twenty four patients with thermal injuries, on whom early excision of eschar was performed, between June and Aug. 2003, were studied. Fascial excision over third and fourth degree burns and tangential excision over indeterminate areas were performed. Superficial and deep layers of eschar was separated and cultivated, and bacterial colony counts performed. The patients were divided into two groups: a colony count equal or greater than 10(5)/g (group A) and less than 10(5)/g (group B), and studied. The plasma endotoxin levels were assayed and compared.
RESULTS: Sepsis occurred at a higher rate when the bacterial colony counts were equal or greater than 10(5)/g at the wound site. Bacterial colonization appears to be greatly increased on the 4th in of escharectomy in superficial layers, and on the 5th in deep layers, in old aged or young child patients tends to occur earlier and with greater severity. The microorganism isolated in all patients was Pseudomonas aeruginosa. There was no statistical difference in the plasma endotoxin levels between groups A and B.
CONCLUSION: It is suggested that all massive burn injuries would be better treated with early excision, within 3 days after burns, especially in old aged or young child patients.
키워드
중증 화상;조기 가피절제술;세균 집락;Massive burns;Early escharectomy;Bacterial colonization
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