Jaundice Occurrence After a Large Area Burn Is a Possible Indication to Delay Surgery
Jaundice Occurrence After a Large Area Burn Is a Possible Indication to Delay Surgery
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大面积烧伤后出现黄疸可能是推迟手术的征兆
DOI：
10.1093/jbcr/irz206
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发表时间：
2020
影响因子：
1.4
通讯作者：
Yuan Bo
中科院分区：
文献类型：
--
作者：
Wang Xiqiao;Yuan Bo
烧伤合并脓毒症患者的死亡率高于创伤患者。脓毒症引起肝功能障碍，是多器官功能障碍综合征和脓毒症死亡的独立危险因素。我们提出的情况下，一个57岁的女性烧伤覆盖59%，她的总体表面积和存在的全层烧伤。她被转移到我们的烧伤中心，由于外观发烧和皮肤黄疸在以前的治疗。根据临床表现，主要采取两种策略：清创术以清除坏死的伤口组织和联合保肝药物治疗。此后一段时间内，患者的病情似乎稳定。皮肤移植覆盖伤口后，意外的是，临床表现迅速恶化。我们可以从这个失败的案例中了解到，黄疸可能是系统性危机的标志。在这种情况下，手术可能会加重病情的严重程度，并导致多器官功能障碍综合征。因此，黄疸可能是皮肤手术不是最佳选择的标志。最佳治疗应加强肝脏保护或提供人工肝支持系统，以促进肝脏从严重脓毒症中恢复。本病例提示烧伤病人在黄疸消退后才应进行植皮手术。
The mortality of burn patients with sepsis is higher than that of trauma patients. Sepsis causes liver dysfunction, which is an independent risk factor for multiple organ dysfunction syndrome and sepsis-induced death. We present the case of a 57-year-old female with burns covering 59% of her total body surface area and the presence of full-thickness burns. She was transferred to our burn center due to the appearance of fever and skin jaundice during the previous treatment. Based on the clinical manifestation, two main strategies were performed: debridement to remove necrotic wound tissue and treatment with a combination of drugs for liver protection. The patient’s condition appeared stable for a period thereafter. Skin grafting to cover the wound was unexpectedly followed by a rapid deterioration in clinical manifestation. We can learn from this failed case that jaundice might be a sign of a systemic crisis. In such cases, surgery could aggravate the severity of the condition and cause multiple organ dysfunction syndrome. Therefore, jaundice may be a sign that skin surgery is not the best option. The optimal treatment should enhance liver protection or provide artificial liver support systems to facilitate the recovery of the liver from severe sepsis. This case suggests that skin graft surgery should not be conducted until jaundice is resolved in burn patients.