重视严重烧伤后期并发持续炎症-免疫抑制-分解代谢综合征

李孝建; 汤文彬

doi:10.3760/cma.j.cn501225-20230131-00030

重视严重烧伤后期并发持续炎症-免疫抑制-分解代谢综合征

doi: 10.3760/cma.j.cn501225-20230131-00030

李孝建^,,
汤文彬

暨南大学附属广州红十字会医院烧伤整形科，广州　　510220

基金项目:

广州市科技计划项目 202102010058

广州市卫生健康科技项目一般引导项目 20221A010016

广州市科学技术局2022年基础研究计划项目-市校联合资助项目 202201020003

详细信息

通讯作者:
李孝建，Email：lixj64@163.com

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出版历程
- 收稿日期: 2023-01-31

Pay attention to persistent inflammation-immunosuppression-catabolism syndrome in the late stage of severe burns

Li Xiaojian^,,
Tang Wenbin

Department of Burns and Plastic Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou 510220, China

Funds:

Guangzhou Science and Technology Plan Project 202102010058

General Guidance Project of Guangzhou Health Science and Technology Projects 20221A010016

The 2022 Basic Research Plan of Guangzhou Science and Technology Office 202201020003

More Information

Corresponding author: Li Xiaojian, Email: lixj64@163.com

摘要

摘要: 随着严重烧伤后脏器并发症的研究不断深入及器官功能监护和支持技术的不断提高，严重烧伤患者在早期和中后期避免了因休克、感染等导致的死亡，进入烧伤后期。其中部分患者因为烧伤创面未能及时和有效愈合，大面积烧伤创面长时间暴露以及感染等，处于发热、消瘦和创面迁延不愈等慢性危重症状态并伴有免疫功能下降、贫血、低蛋白血症等，表现为持续炎症-免疫抑制-分解代谢综合征（PICS），导致住院时间延长、远期病死率升高。该文结合笔者团队烧伤救治的临床实践，对严重烧伤患者后期并发PICS的主要原因及PICS的临床特征、防治方法进行简要阐述，期望引起同行对严重烧伤后期PICS的重视。
- 烧伤 /
- 创面修复 /
- 持续炎症-免疫抑制-分解代谢综合征
Abstract: With the deepening of researches on organ complications after severe burns and the continuous improvement of monitoring and support technology for organ function, severe burn patients have avoided death in the early and middle to late stages due to shock, infection, etc., and entered the late stage of burns. Due to the failure of timely and effective burn wound healing and long-term exposure and infection of extensive burn wounds, some of these patients were in chronic and critical conditions such as fever, emaciation, and delayed wound healing that are accompanied by decreased immune function, anemia, and hypoproteinemia, etc. It manifested as persistent inflammation-immunosuppression-catabolism syndrome (PICS), leading to prolonged hospitalization and increased long-term mortality. Based on clinical practice of the author's team in burn treatment, this paper briefly expounds the main causes, clinical characteristics, and prevention methods of PICS in the late stage of severe burns of patients, hoping to attract the attention of peers to PICS in the late stage of severe burns.
- Burns /
- Wound repair /
- Persistent inflammation-immunosuppression-catabolism syndrome
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参考文献(18)

[1]	罗高兴.烧伤后脏器并发症的发生与防治[J].中华烧伤杂志,2019,35(8):565-567.DOI: 10.3760/cma.j.issn.1009-2587.2019.08.002.
[2]	郇京宁,黄晓琴.控制大面积烧伤患者过度液体复苏预防并发症[J].中华烧伤与创面修复杂志,2022,38(1):13-20.DOI: 10.3760/cma.j.cn501120-20210813-00281.
[3]	房贺,徐龙,朱峰.持续炎症-免疫抑制-分解代谢综合征在危重烧伤中的研究进展[J].中华烧伤杂志,2019,35(7):548-551.DOI: 10.3760/cma.j.issn.1009-2587.2019.07.015.
[4]	HawkinsRB,RaymondSL,StortzJA,et al.Chronic critical illness and the persistent inflammation,immunosuppression,and catabolism syndrome[J].Front Immunol,2018,9:1511. DOI: 10.3389/fimmu.2018.01511.
[5]	LamasD.Chronic critical illness[J].N Engl J Med,2014,370(2):175-177.DOI: 10.1056/NEJMms1310675.
[6]	GentileLF,CuencaAG,EfronPA,et al.Persistent inflammation and immunosuppression: a common syndrome and new horizon for surgical intensive care[J].J Trauma Acute Care Surg,2012,72(6):1491-1501.DOI: 10.1097/TA.0b013e318256e000.
[7]	YangN,LiB,YeB,et al.The long-term quality of life in patients with persistent inflammation-immuno-suppression and catabolism syndrome after severe acute pancreatitis: a retrospective cohort study[J].J Crit Care,2017,42:101-106.DOI: 10.1016/j.jcrc.2017.07.013.
[8]	StortzJA,MurphyTJ,RaymondSL,et al.Evidence for persistent immune suppression in patients who develop chronic critical illness after sepsis[J].Shock,2018,49(3):249-258.DOI: 10.1097/SHK.0000000000000981.
[9]	刘军.持续炎症-免疫抑制-分解代谢综合征的共识与争议[J].中华医学杂志,2019,99(13):961-964.DOI: 10.3760/cma.j.issn.0376-2491.2019.13.001.
[10]	EfronPA,MohrAM,BihoracA,et al.Persistent inflammation, immunosuppression, and catabolism and the development of chronic critical illness after surgery[J].Surgery,2018,164(2):178-184.DOI: 10.1016/j.surg.2018.04.011.
[11]	MiraJC,GentileLF,MathiasBJ,et al.Sepsis pathophysiology, chronic critical illness, and persistent inflammation-immunosuppression and catabolism syndrome[J].Crit Care Med, 2017,45(2):253-262. DOI: 10.1097/CCM.0000000000002074.
[12]	罗鹏, 张博涵, 孙佳辰, 等. 严重烫伤大鼠早期胰腺外分泌功能变化的机制研究[J]. 中华烧伤与创面修复杂志, 2023, 39(5): 424-433. DOI: 10.3760/cma.j.cn501225-20230216-00051.
[13]	陈诺, 席毛毛, 阮琼芳, 等. 大面积烧伤患者发生早期心肌损伤的危险因素及早期心肌损伤对预后的影响[J]. 中华烧伤与创面修复杂志, 2023, 39(5): 417-423. DOI: 10.3760/cma.j.cn501225-20230308-00074.
[14]	OsborneT, WallB, EdgarDW, et al.Current understanding of the chronic stress response to burn injury from human studies[J/OL]. Burns Trauma, 2023,11: tkad007[2023-04-28]. https://pubmed.ncbi.nlm.nih.gov/36926636/. DOI: 10.1093/burnst/tkad007.
[15]	汤文彬, 陈宾, 欧莎莉, 等. 大面积烧伤患者继发持续炎症-免疫抑制-分解代谢综合征的危险因素分析 [J]. 中华烧伤与创面修复杂志, 2023, 39(4): 350-355. DOI: 10.3760/cma.j.cn501225-20220214-00028.
[16]	汤文彬,李孝建,邓忠远,等.统一创面手术方案对大面积深度烧伤患者治疗结果的影响[J].中华烧伤杂志,2015,31(4):254-258.DOI: 10.3760/cma.j.issn.1009-2587.2015.04.004.
[17]	李孝建,张志,霍丽贞,等.自体与异体活体小皮片混合移植治疗大面积深度烧伤的临床研究[J/CD].中华损伤与修复杂志:电子版,2009,4(6):651-655.DOI: 10.3969/j.issn.1673-9450.2009.06.005.
[18]	SongH, YuanZ, PengY, et al. Extracorporeal membrane oxygenation combined with continuous renal replacement therapy for the treatment of severe burns: current status and challenges[J/OL]. Burns Trauma, 2021, 9:tkab017[2023-04-28]. https://pubmed.ncbi.nlm.nih.gov/34212063/. DOI: 10.1093/burnst/tkab017.