911例特重度烧伤患者临床分析

Clinical analysis of 911 patients with specially severe burn

目的总结特重度烧伤患者流行病学资料、并发症、治疗方法、治疗结果。方法 2005年1月—2016年9月笔者所在科共收治特重度烧伤烧伤患者911例,运用SPSS软件建立数据库,就其流行病学资料、并发症、治疗方法、治疗结果做统计学分析。结果成人特重度烧伤占59.71%,小儿特重度烧伤患者占40.30%;吸入性损伤发生率19.09%(174例);创面脓毒症发生率8.67%(79例);烧伤并发症发生率高,前三位是低蛋白血症(36%)、贫血(24.14%)、肺部感染(4.93%)。治愈率61.1%(557例),好转率29.7%(271例),自动出院72例(7.9%),死亡11例(1.2%)。死亡原因是重度吸入性损伤和多器官功能衰竭。结论目前我国烧伤治疗技术达到较高水平,死亡率下降;由于基层医疗条件提高,早期能够有效地进行液体复苏;由于交通发达,患者能够得到及时转运;农村地区留守儿童热液烫伤发生率居高不下,应当引起重视;早期预防性气管切开、纤维支气管镜应用、呼吸机早期应用,使吸入性损伤救治水平提高;难愈性创面负压封闭引流治疗(VSD)得到普及;悬浮床、电动取皮刀、MEEK植皮技术得到广泛应用。连续性血液滤过技术(CRRT)应用逐渐增加。特重度烧伤患者花费巨大,部分患者无法完全治愈出院,是现实的社会问题。

Objective To summarize the epidemiological data of patients with severe bum,complications, therapeutic methods and treatment outcome. Methods The 911 specially severe bum patients treated in author＇s department from Jan. 2005 to Sept. 2016yr. were collected and analyzed;By using SPSS software to establish database,and statistical analysis had been done. Results Adult specially severe bums accounted for 59.71%, Children with specially severe bum accounted for 40.30%. The incidence of inhalation injury was 19.09%. The incidence of sepsis was 8.67%. The incidence of bum complications was high,the top three were hypoproteinemia, anemia,pulmonary infections. The cure rate was 61.1%（557/911）. The rate of improvement was 29.7%（271/911）. Automatic discharge in 72 cases （7.9%）;11 cases died. The causes of death were severe inhalation injury and multiple organ failure. Conclusions At present,the bum treatment technology in our country has reached a high level,and the mortality rate has decreased. Due to the improvement of primary medical conditions ,early effective liquid resuscitation can be done. Due to the advanced traffic,the patients can get timely transportation. The high incidence of scald in left-behind children in mral areas should be paid attention to. Early preventive traeheotomy, the application of fiberoptic bronchoscopy,the early application of the ventilator,so that the level of inhalation injury treatment significantly improved. Vacuum sealing drainage technique widely used in difficult healing wound. Suspension bed,electric dermatome,MEEK free skin grafting technique has been widely applied in clinical practice. The clinical application of continuous hemofiltration technology is gradually increasing. It is a realistic social problem that the cost of the patients with specially severe hum is huge,and some patients can not be cured completely.