新型冠状病毒肺炎疫情期间烧伤伴吸入性损伤患者的救治体会

Experience in the treatment of burn patients combined with inhalation injury during the epidemic of coronavirus disease 2019

目的介绍新型冠状病毒肺炎(COVID-19)疫情期间烧伤伴吸入性损伤患者的救治体会。方法2020年2月1日—3月1日COVID-19疫情高发期间武汉大学同仁医院暨武汉市第三医院烧伤科收治烧伤伴吸入性损伤患者6例,其中男4例、女2例,年龄为21~63岁,入院时间为伤后2~4 h,烧伤总面积为1%~20%TBSA,Ⅲ度烧伤面积为1%~12%TBSA。其中1例重度吸入性损伤、2例轻度吸入性损伤、3例中度吸入性损伤。患者入院时体温均正常,近2周无发热、咳嗽。入院时,1例患者胸部CT示双肺下叶、左肺上叶见多发条片状及结节稍高密度影,2例患者胸部CT示双肺纹理增粗,其余患者胸部CT正常。入院后给予6例患者常规治疗,期间医护人员注意防护,并参照COVID-19诊疗方案筛查COVID-19。伤后1、3、6、9 d取患者静脉血检测白细胞计数、中性粒细胞、淋巴细胞绝对值、降钙素原水平。伤后3、6 d行实时荧光定量反转录PCR新型冠状病毒核酸检测。入院后记录患者体温。记录伤后1周内胸部CT检查结果和患者的预后情况。呈正态分布的计量资料以±s表示,非正态分布的计量资料以M(P25,P75)表示。结果(1)伤后1、3、6、9 d患者的白细胞计数分别为(19.8±3.8)×10^9/L、(17.2±3.4)×10^9/L、(13.3±3.1)×10^9/L、(11.1±1.6)×10^9/L,中性粒细胞分别为0.919±0.019、0.899±0.011、0.855±0.034、0.811±0.035,淋巴细胞绝对值分别为(0.65±0.18)×10^9/L、(0.65±0.24)×10^9/L、(0.91±0.34)×10^9/L、(1.23±0.42)×10^9/L,降钙素原水平分别为0.49(0.36,1.64)、0.39(0.26,0.73)、0.28(0.18,0.33)、0.12(0.11,0.20)ng/mL;白细胞计数、中性粒细胞均高于正常值,呈下降趋势;淋巴细胞绝对值于伤后6 d起恢复至正常值;降钙素原水平均高于正常值。(2)伤后3、6 d,6例患者新型冠状病毒核酸检测结果均呈阴性。6例患者体温波动范围为36.5~38.6℃。伤后1周内6例患者胸部CT未筛查出COVID-19典型影像学特征。治疗14~32 d,6例患者均治愈出院。结论在COVID-19疫情期间,烧伤伴吸入性损伤患者应在做好医护防护的条件下救治,同时应积极排查病毒,减少医患感染COVID-19风险。

Objective To introduce the experience in treating burn patients with inhalation injury during the epidemic of coronavirus disease 2019(COVID-19).Methods Six burn patients combined with inhalation injury were hospitalized in Department of Burns of Tongren Hospital of Wuhan University&Wuhan Third Hospital from February 1 to March 1 in 2020 during the high-incidence period of COVID-19,including 4 males and 2 females,aged 21-63 years,admitted at 2-4 hours after burns,with total burn areas of 1%-20%total body surface area(TBSA)and full-thickness burn areas of 1%-12%TBSA.Among them,1 case had severe inhalation injury,2 cases had mild inhalation injury,and 3 cases had moderate inhalation injury.The body temperatures of the patients were normal at the time of admission,with no fever or cough in the past 2 weeks.At admission,chest CT of one patient showed double lower lobes and left upper lobes had multiple slices and slightly high-density shadow of nodules.Chest CT of two patients showed thickening of bilateral lung texture,and the chest CT of remaining patients were normal.After admission,6 patients were given routine treatment,the medical staffs paid attention to the protection and screened for COVID-19 according to the diagnosis and treatment plan of COVID-19.On post injury day(PID)1,3,6,and 9,vein blood of patients were collected for determination of white blood cell(WBC)count,neutrophil,lymphocyte absolute value,and level of procalcitonin(PCT).Nucleic acid of novel coronavirus was detected by real-time fluorescence quantitative reverse transcription polymerase chain reaction on PID 3 and 6.The temperatures of patients were recorded after admission.The results of chest CT within one week after injury and the prognosis of the patients were recorded.Measurement data distributed normally were expressed as±s,and measurement data distributed abnormally were expressed as M(P25,P75).Results(1)On PID 1,3,6,and 9,WBC counts of patients were respectively(19.8±3.8)×10^9/L,(17.2±3.4)×10^9/L,(13.3±3.1)×10^9/L,and(11.1±1.6)×10^9/L,neutrophils of patients were respectively 0.919±0.019,0.899±0.011,0.855±0.034,and 0.811±0.035,absolute values of lymphocytes of patients were respectively(0.65±0.18)×10^9/L,(0.65±0.24)×10^9/L,(0.91±0.34)×10^9/L,and(1.23±0.42)×10^9/L,and PCT values of patients were respectively 0.49(0.36,1.64),0.39(0.26,0.73),0.28(0.18,0.33),and 0.12(0.11,0.20)ng/mL.The values of WBC and neutrophils of patients were higher than the normal value,showing a downward trend.The absolute values of lymphocyte of patients returned to the normal value from PID 6.The PCT values of patients were higher than the normal value.(2)Nucleic acid test results of novel coronavirus of 6 patients were negative on PID 3 and 6.The temperatures of 6 patients ranged from 36.5 to 38.6℃.The typical imaging features of COVID-19 were not found in 6 patients within 1 week after injury by chest CT.After treatment for 14-32 days,6 patients were cured and discharged.Conclusions During COVID-19 pandemic,burn patients combined with inhalation injury should be treated under condition of good protection for doctors and nurses.Meanwhile,virus should be actively screened to reduce the risk of COVID-19 infection among doctors and patients.