特大成批危重烧伤患者35例的成功救治经验

Successful experiences in treating thirty-five burned victims in a single batch transferred from a remote area

目的介绍一组特大成批危重烧伤患者成功转运救治的经验。方法2006年5～8月,解放军总医院第一附属医院烧伤科主持并参加了一组35例特大成批危重烧伤患者伤后6h急救、空中和陆路长途转运、后续治疗的工作。35例患者均为男性,年龄22.4±8.7(17～46)岁,烧伤面积13.6%±12.9%(4%～75%)TBSA;特重度烧伤3例,重度烧伤29例,轻度烧伤3例;全部患者均有头面部烧伤,32例患者伴有中、重度吸入性损伤,20例伴双手深度烧伤(计39只手)。当地医院行15例气管切开,17例四肢切开减张。经充分的转运前准备后,35例患者经4h空中和陆路长途转运,顺利抵达接收地。收入解放军总医院第一附属医院烧伤科的23例病情相对危重患者中,并发多器官功能障碍综合征(MODS)1例、特重2例、病重12例,均有不同程度的心、肺、肝、肾功能及凝血功能异常。入院后连续月余予以全方位抢救治疗,先后进行手术48例次。结果35例患者全部救治成功(包括其他医院的12例),功能及外观恢复满意。结论本批烧伤患者早期救治延迟,转运路途远,伤情重,并发症多,接诊及救治难度大。救治过程中有以下几点体会:从现场救治、长途转运到后续治疗,应组织得力、分工明确、团结协作;整体治疗应尽量规范统一,强调个体化治疗;尽快处理危及生命的并发症;尽早封闭烧伤创面,从源头上清除感染根源,使用抗炎药物,减轻炎症过度反应。强调营养、代谢和免疫调理、凝血功能障碍的纠正等是本批患者成功救治的关键;重视应用整形美容的原则和技术处理面部和手部等关节部位创面,是功能和外貌恢复良好的保证。

Objective To introduce the successful experiences in treating 35 burned victims transferred from a remote area.Methods Thirty-five burned casualties were transferred to our burns institute from a remote area on the post-burn day 2,May 28,2006.All of them were males,age ranged from 17 to 46 years with mean of 22.4±8.7 years.The mean total burned area was 13.6%±12.9% TBSA（ranged from 4% to 75%）.Among them,32 patients also manifested the signs of severe inhalation injury.In all of the patients,heart function,pulmonary function,liver function,renal function,and coagulation function were abnormal.Therefore,they were in critical condition with multiple complications,demanding most meticulous care.On this occasion,our strategies consisted of dispatching experienced surgeons and nurses to the referring hospitals and the airport to accept the patients to give appropriate care to them during the journey.The medical staff was well organized to insure that each of them was ordained specific duty.The conditions of patients were evaluated immediately and appropriate treatment was expeditiously started to arrest those lethal complications on arrival.Timely and exact comprehensive treatments were prerequisite to save the patients＇ life.Adequate metabolic support should be emphasized,and either coagulant or anticoagulant treatment should be given when indicated.Results All of the patients survived.Conclusion In dealing with mass burn casualties,organizational work is essential to prevent any untoward complications during the transportation,and the staff of the receiving hospital sheald also be organized to treat any life-threatening conditions on arrival of the palients.Meticulous care should be given to all the patients,and fatal complications are expeditionsly treated in order to achieve a satisfactory result.