烧伤总面积≥80%且Ⅲ度烧伤面积≥50%的特重度烧伤54例救治分析

Analysis of 54 patients with total burn surface area over 80% and full-thickness burn over 50%

目的:通过两阶段烧伤总面积≥80%且Ⅲ度烧伤面积≥50%特重度烧伤患者基本情况的对比分析,探讨进一步提高烧伤救治率的有效措施。方法:入选1987～2006年20年间安徽医科大学第一附属医院烧伤科收治的烧伤总面积≥80%且Ⅲ度烧伤面积≥50%的特重度烧伤患者共54例,将这些患者分为两组,A组为1987～1996年入院的患者,B组为1997～2006年入院的患者。对两组患者的年龄、性别、致伤原因、烧伤面积和深度、烧伤指数、液体复苏、吸入性损伤、手术情况、死亡原因和死亡率等进行对比分析。结果:A组和B组患者的烧伤严重程度无差别,吸入性损伤的发生率相似,致伤原因和死亡原因也类似,B组患者休克期液体复苏总量和尿量较大,预防性气管切开应用广泛,早期手术更积极,患者死亡率为63.3%,明显低于A组的95.8%,且B组死亡的患者存活时间较A组显著延长[(17.32±13.18)dvs(9.35±11.59)d]。结论:重视纠正低氧和保持呼吸道通畅,及时有效充分的液体复苏,早期切削痂,自异体皮移植覆盖创面等是此类特重大面积烧伤患者抢救成功的关键。

Objective： The aim of this two-phase comparative study was to analyze the management of the extensively burned patients with total burn surface area over 80% and full-thickness （FT） burn over 50% so as to decrease the morbidity and mortality. Methods： Fifty-four burn patients whose burn size over 80% and FT burn area over 50% were admitted to our department over the 20 years period from 1987 to 2006. On the basis of admission time, these severely burned patients were divided into two groups： Group A, admitted between 1987 to 1996, and Group B, admitted between 1997 to 2006. Data on age, gender, cause of burn, size and depth of burn, burn indices, fluid resuscitation, inhalation injury, burn related surgery, cause of death and mortality rate were collected and compared. Results： No significant difference was found in the severity of burns, inhalation injury, cause of burn and cause of death between the two groups. However, the patients in group B received a higher mean resuscitation fluid volume and had a higher urine output dining the shock period. Early excision and grafting and prophylactic tracheotomy was more performed in group B. Mortality in group B was significantly lower than in group A （63.3% vs 95.8%） and survival was longer in group B [（17.32±13.18） d vs （9.35±11.59） d]. Conclusion： These results show that refinements in burn shock resuscitation, and advances in early wound excision, skin grafting and respiratory management were associated with decreased morbidity and mortality after severe burn.