Ⅲ度烧伤面积≥90%烧伤患者30例救治分析

30 cases of severe burn patients with third degree area more than 90% TBSA

目的总结Ⅲ度≥90%烧伤的特点及救治经验。方法通过分析辽宁省4家医院烧伤科1987～2012年Ⅲ度≥90%烧伤30例病例资料,对其伤情特点及治疗方案进行探讨。治疗要点包括及时合理的抗休克补液、早期气管切开、早期大面积切痂微粒皮移植,此外,营养治疗及抗感染治疗也贯穿整个治疗过程。结果 30例患者治愈8例,各种原因死亡22例。结论Ⅲ度≥90%烧伤伤情极其危重,休克发生早而重,往往伴有吸入性损伤,更易出现MODS及严重感染。及时、正确而有效的个体化抗休克治疗,早期及时气管切开,早期分次大面积切痂并有效封闭创面,有计划充分合理利用残存自体皮供区,合理的感染防治措施,肠内外营养方案在不同时期的合理运用,是Ⅲ度≥90%烧伤患者救治成功的必要措施。

Objective To summarize the experiences in treatment of burned patients with third degree area more than 90%TBSA.Methods Thirty patients with third degree area more than 90%TBSA during 1987 to 2012 from four burn units in Liaoning Province were enrolled in this study to explore the characteristic of this kind of severe burns and experiences in treatment.The major treatment included optimal fluid resuscitation,incision of trachea in early stage,early escharectomy,microskin grafting and alloskin grafting.In addition,nutrition support and reasonable antibiotics therapy were also adopted.Results Eight patients out of thirty were rescued,others died of several subsequent syndromes.Conclusions In patients withⅢ degree≥90%TBSA,shock occurred early and severely,accompanied with inhalation injury,made patients in face of high risk of die.The keypoints to rescue those patients lied on:effective and in time fluid resuscitation,in time incision of trachea in early stage,planed early large area escharectomy,effective use of autologous skin to cover the wounds,appropriate application of antibiotics and reasonable application of enteral and parenteral nutrition program at different stages.