年龄对烧伤患者半数致死烧伤面积的影响

Influence of age on median lethal burn area of burn patients

目的 探讨年龄对烧伤患者LA50的影响. 方法 （1）将笔者单位1958年12月一2004年12月收治的23 073例患者分为25个年龄段,采用SPSS 11.0统计软件中的Probit模块通过概率单位回归方法,分别计算各年龄段患者烧伤总面积和Ⅲ度面积LA50.（2）合并LA50相近的年龄段形成4个新的年龄段再分别计算烧伤总面积和Ⅲ度面积LA50及其95％置信区间（CI）.（3）根据入院时间,将患者分为A组（1958年12月1日-1983年12月31日入院）和B组（1984年1月1日-2004年12月31日入院）,分别计算2组患者4个新的年龄段烧伤总面积和Ⅲ度面积LA50及其95％ CI. 结果 （1）25个年龄段患者烧伤总面积和Ⅲ度面积LA50：小于或等于5岁偏低,5岁以后有所提高,15岁后明显提高,60岁以后又明显下降.（2）合并后4个年龄段患者烧伤总面积和Ⅲ度面积LA50最低者,分别为大于60岁（50.90％ TBSA）和小于或等于5岁年龄段（35.81％ TBSA）,最高者,为大于15岁且小于或等于60岁年龄段（89.38％、59.22％ TBSA）.4个年龄段患者烧伤总面积、Ⅲ度面积LA50总体比较,差异均有统计学意义.烧伤总面积LA50的95％ CI从低龄到高龄依次为56.87％ ～64.69％、64.46％～74.36％、85.89％ ～93.37％、44.55％～60.73％ TBSA,Ⅲ度面积LA50的95％ C1依次为32.67％～39.69％、40.86％～50.41％、55.27％ ～ 63.85％、32.46％ ～54.86％TBSA.（3）A组患者烧伤总面积和Ⅲ度面积LA50分别为69.61％、39.79％TBSA,明显低于B组的98.94％、73.23％ TBSA.2组内不同年龄段患者LA50差异仍然存在,2组间各年龄段患者LA50变化趋势基本一致.除去大于5岁且小于或等于15岁患者烧伤总面积LA50和大于60岁患者Ⅲ度面积LA50外,2组间其余年龄段患者之间烧伤总面积和Ⅲ度面积LA50比较,差异具有统计学意义.2组中小于或等于5岁、大于15岁且小于或等于60岁及大于60岁患者烧伤总面积LA50的95％ CI分别为48.38％ ～ 56.07％与68.68％～81.35％ TBSA、75.91％ ～ 84.89％与97.09％ ～ 110.45％ TBSA、30.08％ ～45.08％与60.67％ ～ 102.69％ TBSA,2组中小于或等于5岁、大于5岁且小于或等于15岁、大于15岁且小于或等于60岁患者Ⅲ度面积LA50的95％ CI分别为27.48％ ～ 34.69％与42.09％～54.03％ TBSA、34.78％ ～46.43％与49.62％～69.47％ TBSA、43.98％～51.77％与66.43％～77.99％TBSA. 结论 年龄是影响LA50的重要因素之一,各年龄段LA50随着医疗技术的进步而提高,但年龄对LA50的影响不会因治疗水平的提升而明显改变.

Objective To discuss the influence of age on the LA50 （the burn area lethal to 50％ of patients） of burn patients.Methods （1） Twenty-three thousand and seventy-three burn patients hospitalized in our center from December 1958 to December 2004 were enrolled,and they were divided into 25age groups.LA50 values of total and full-thickness burn areas of patients in each age group were computed with probit regression method with Probit analysis of SPSS 11.0.（2） Those age groups with similar LA50values were merged into one age group; thus 4 new age groups were formed.LA50 and its 95％ confidence interval （CI） of total and full-thickness burn areas of patients in each age group were computed respectively.（3） All the patients were divided into group A （admitted from 1 December 1958 to 31 December 1983） and group B （admitted from 1 January 1984 to 31 December 2004） according to the admission time.LA50 and its 95％ CI of total and full-thickness burn areas of patients in each age group of groups A and B were computed respectively.Results （1） LA50 values of total and full-thickness burn areas of patients among the 25 age groups were low in age groups younger than or equal to 5 years,which increased in age groups older than 5 years,distinctly higher in age groups older than 15 years,and they became lower in age groups older than 60 years.（2） LA50 values of total and full-thickness burn areas of patients in the 4 merged age groups were lowest in age groups older than 60 years （50.90％ TBSA） and younger than or equal to 5 years（35.81％ TBSA）,and highest in age group older than 15 years and younger than or equal to 60 years （89.38％ and 59.22％ TBSA）.There were statistically significant differences in LA50 of total and fullthickness burn areas of patients among 4 merged age groups [with 95％ CI values of LA50 of total burn areas of patients in age groups ranging from young to old respectively （56.87 to 64.69） ％,（64.46 to 74.36） ％,（85.89 to 93.37） ％,（44.55 to 60.73） ％ TBSA ; with 95％ CI values of LA50 of full-thickness burn areas of patients in age groups from young to old respectively （32.67 to 39.69） ％,（40.86 to 50.41） ％,（55.27to 63.85） ％,（32.46 to 54.86） ％ TBSA].（3） LA50 values of total and full-thickness burn areas of patients in group B （98.94％ and 73.23％ TBSA） were significantly higher than those in group A （69.61％and 39.79％ TBSA）.There were differences in LA50 values of patients among different age groups in both group A and group B.The variation trend of LA50 values of patients among the 4 age groups in groups A and B was almost the same.Except for LA50 of total burn areas of patients in age group older than 5 years and younger than or equal to 15 years and LA50 of full-thickness burn areas of patients in age group older than 60 years,there were statistically significant differences in the LA50 of total and full-thickness burn areas of the other patients between group A and group B [with 95％ CI of LA50 of total burn areas of patients of younger than or equal to 5 years,older than 15 years and younger than or equal to 60 years,and older than 60 years respectively （48.38 to 56.07）％ and （68.68 to 81.35）％ TBSA,（75.91 to 84.89）％ and （97.09 to 110.45） ％ TBSA,（30.08 to 45.08） ％ and （60.67 to 102.69） ％ TBSA ; with 95％ CI of LA50 of fullthickness burn areas of patients of younger than or equal to 5 years,older than 5 years and younger than or equal to 15 years,older than 15 years and younger than or equal to 60 years respectively （27.48 to 34.69） ％and （42.09 to 54.03）％ TBSA,（34.78 to 46.43）％ and （49.62 to 69.47）％ TBSA,（43.98 to 51.77）％ and （66.43 to 77.99）％ TBSA].Conclusions Age is one of the important factors that influence the LA50 of burn patients.LA50 in different age groups increases with the development of medical technology; however,the influence of age on LA50 is not visibly changed by the advance of treatment.