华东地区615例化学烧伤患者流行病学调查

Epidemiological investigation of 615 patients with chemical burns in eastern China

目的探讨化学烧伤的现场急救、早期处理和治疗方法中的流行病学因素。方法整理笔者单位2001年1月-2010年12月收治的2682例烧伤患者中615例化学烧伤患者病例资料，对性别、年龄、致伤面积与深度、发病规律、致伤原因、致伤物质、致伤部位、合并症、院前处理情况、治疗肢颅后情况等进行归纳总结。采用线性趋势检验统计分析年度收治的烧伤患者总数、化学烧伤人数。结果（1）一般情况：本组病例中男562例占91．4％，女53例占8．6％，年龄（32±12）岁。烧伤总面积为1％～95％[（30±25）％]TBSA，其中Ⅲ度面积0—85％[（18±24）％]TBSA。（2）发病规律：10年中笔者单位每年收治的烧伤患者总数呈缓慢增长趋势（χ2=4．009，P〈0．05），但化学烧伤患行所占比例相关不大（χ2=0．060．P〉0．05）。本组化学烧伤高发于夏秋季，患者一般从4月开始逐渐增多，8月达到高峰，之后逐渐减少。（3）致伤原因：患者以工伤为主，共572例占93．0％，其中私营和民营企业工人占工伤患者的70．8％（405／572）。（4）致伤物质：本组病例中以酸烧伤最多，共299例占48．6％。（5）致伤部位：四肢和头颈部等暴露部位最易受伤。（6）合并症：吸入性损伤47例107．6％，眼烧伤94例占15．3％，复合伤51例占8．3％，中毒67例占10．9％。（7）院前处理情况：大部分患者伤后未经清水冲洗（30．4％，187／615）或清水冲洗不够充分（61．1％，376／615）。（8）治疗及预后情况：212例（34．5％）患者在伤后1周内行切削痂植皮或皮瓣移植手术。本组患者治愈599例，其中8例共11只眼睛失明；死亡16例，死亡率为2．6％。结论笔者单位化学烧伤患行占同期收治烧伤忠者总数比例相对较高，以工伤为主。化学烧伤救治的关键在于充分的早期冲洗和解毒，深度创面尽早切削痂可以减少机体对有毒物质的吸收。

Objective To investigate the epideminlogical factors in the first aid, early management, and treatment of chemical hurns. Methods Medical records of 615 inpalients with chemical burns out of 2682 burn patients hospitalized from January 2001 to December 2010 were screened to retrospectively analyze the clinical data, inclnding gender, age, burn area and depth, oceurrence regularity, injury cause, injury- causing chemicals, wound site, complications, pre-hospital management, treatment and prognosis. Annual number nf burn patients and annual number of patients with chemical burns were statistically analyzed with linear trend test. Results （ 1 ） Among all the ehemical burn patients, 562 （91.4%） were male and 53 （8.6%） female. The mean age of patients was （32±12） years. Burn area ranged from 1% to 95% , with mean area of （30 ± 25 ）% TBSA. Full-thiekness burn area ranged from 0 to 85% , with mean area of （ 18 ± 24 ） % TBSA. （2） The annual number of burn patients showed a slow trend of increase dnring the last dec- ade （ χ2 =4. 009, P 〈0.05 ）. There was no statistically significant differenee in the annual number of pa- tients with chemical burns among the last decade （χ2 = 0. 060, P 〉 0.05）. Chemical burns mainly oc- curred in summer and autumn, and the incidence gradually increased in April, peaked in August, and then gradually decreased. （ 3 ） Five hundred and seventy-two cases （93.0%） were injured while working, among these patients 70.8% （405/572） were injured in private enterprises. （4） Acid was the most common inju- ry-causing chemical （299 patients, accounting for 48.6% ）. （5） The extremities and head were the most involved areas. （6） Among 615 patients with chemical burns, 47 eases （7.6%） were complicated by inha- lation injury, 94 cases （15.3%） by ocular burns, 51 eases （8.3%） by combined injury, and 67 cases（10.9%） by poisoning. （7） Most patients did not receive （30. 4%, 187/615 ） or only insufficient （61.1%, 376/615） immediate irrigation after injury in pre-hospital management. （8） Two hundred and twelve patients （34.5%） underwent skin grafting or flap transplantation after early total or tangential exci- sion of eschar within one week post injury. Among all the patients, 599 cases were cured with 11 eyes be- coming blind in 8 patients, and sixteen patients died with a mortality rate of 2.6%. Conclusions Pa- tients with chemical burns aecounted for a high proportion of the burn patients admitted to our unit in the same period, and they were mainly injured while working. Sufficient irrigation and immediate detoxification are key points in the treatment of chemical burns. Early total or tangential excision of esehar of deep wounds could reduce the possibility of poisoning.