成批烧伤患者的综合救治

Comprehensive treatment of mass burns from chemical factory

目的总结分析化工企业成批烧伤患者的救治方法与应对措施。方法以2003年1月—2011年11月收治的成批烧伤患者为研究对象,其中2003年1月—2006年12月循常规接诊与抢救治疗程序,设为历史对照组;2007年1月—2011年11月12月为治疗组,治疗中采用程序化组织管理方案,给予化学烧伤及烧冲复合伤的个性化治疗,包括预防性气管切开、全身支持与局部治疗、手术植皮等。观察2组患者治愈率、死亡率、平均手术次数、创面愈合时间、休克发生率、脓毒症发生率等临床指标的差异。结果共收治22批378例患者,其中对照组10批183例,治疗组12批195例。2组患者治愈率差异无统计学意义(治疗组比对照组:95.36%与88.52%)(P>0.05)。治疗组患者死亡率低于对照组(治疗组比对照组:4.61%与11.48%)。实施手术治疗的患者中,特重度烧伤患者创面愈合时间分别为治疗组(89.46±11.42)d比对照组(101.27±13.95)d;重度烧伤患者创面愈合时间分别为治疗组(51.64±14.32)d比对照组(66.04±16.84)d;中度烧伤患者创面愈合时间分别为治疗组(42.83±15.50)d比对照组(66.77±19.34)d;2组患者创面愈合时间差异均有统计学意义(P<0.05)。实施非手术治疗的患者中,治疗组患者94例(48.21%),创面愈合时间(26.12±4.31)d,对照组患者89例(48.63%),创面愈合时间为(26.71±4.12)d,2组比较差异无统计学意义(P>0.05)。结论程序化组织管理结合整体治疗和个体化治疗,能够缩短患者创面愈合时间,减少死亡率、休克及感染发生率,提高患者治愈率,具有更好的临床救治效果。

Objective To summarize the clinical treatment of mass burns suffered in chemical factories. Methods Adult mass burns presented our hospital between Jan. 2（D3 and Nov. 2011 was included in this study. Patients treated with routine methods between Jan. 2003 and Dec. 2006 were regarded as control group, and patients treated with new integration treatment program between Jan. 2007 and Nov. 2011 were regarded as experiment group. The integration treatment program consisted of programmable management, individual treatment of chemical bums and bum -blast combined injuries （with preventive tracheotomy, systemic support, local treatment and skin grafting included）. Cure rates, mortality, operation number, wound healing duration, shock and sepsis incidence were observed to evaluate outcome of this treatment system. Results A total of 378 mass burn patients in 22 batches were admitted, among which 183 cases in 10 batches located in control group and the others in experiment group. Finally there were 186 cases cured with a high cure rate of 95.36%. The mortality of experiment group was significantly lower than that in control group （4.61% vs. 11.48% ）. The wound healing duration of major bums, severe burns, moderate bums in experiment were much shorter than those in control group （ 89.46±11.42） d vs. （ 101.27 ± 13.95 ） d, （51.64± 14.32） d vs. （66.04 ± 16. 84） d, （42.83± 15.50） d vs. （66.77±19.34） d, respectively. In non - operation patients, 94 cases in experiment group healed within 26. 12 ±4.31 days and 89 cases in control group healed within 26.71±4. 12 days. Conclusion The comprehensive treat- ment system includes with programmable organization, systemic and local treatment, benefit treatment of mass burns by accelerating wound healing, decreasing mortality, shock and sepsis incidence and improving cure rate.