35例不同妊娠时期烧伤患者的回顾性分析

Retrospective analysis of 35 burn patients in different stages of pregnancy

目的总结不同妊娠时期烧伤患者的临床结局,探讨妊娠期烧伤的合理处理方案。方法采用回顾性观察性研究方法。2010年6月—2020年6月,武汉市第三医院烧伤科收治21例和南昌大学第一附属医院烧伤科收治14例符合入选标准的妊娠烧伤患者。根据烧伤时的孕期,将35例患者分为妊娠早期组[18例,年龄(26±4)岁,孕期8(4,11)周]、妊娠中期组[10例,年龄(26±3)岁,孕期21(14,27)周]、妊娠晚期组[7例,年龄(30±5)岁,孕期32(29,35)周]。患者均接受液体复苏、抗感染、创面处理及多学科综合救治等治疗。统计3组患者在治疗过程中出现的烧伤并发症、孕妇结局、胎儿结局、分娩方式、分娩孕周、新生儿体重。对数据行单因素方差分析、Kruskal-Wallis检验、Fisher确切概率法检验。结果在治疗过程中,妊娠早期组、妊娠中期组、妊娠晚期组分别有4、4、2例患者出现创面感染,有1、3、2例患者出现休克症状,组间总体比较,差异均无统计学意义(P>0.05);妊娠晚期组中有1例患者在清创术后出现多器官功能障碍综合征。3组孕妇最终均存活,组间总体比较,差异无统计学意义(P>0.05)。妊娠早期组、妊娠中期组、妊娠晚期组分别有9、8、6例患者的胎儿存活,组间总体比较,差异无统计学意义(P>0.05)。3组患者的胎儿死产、足月产情况均相近(P>0.05);3组患者的胎儿流产和早产情况均差异明显(P<0.05或P<0.01),且妊娠早期组患者的胎儿流产最多、早产最少。3组患者中胎儿存活患者的分娩方式、分娩孕周、新生儿体重组间总体比较,差异均无统计学意义(P>0.05)。结论对于妊娠早、中、晚期烧伤患者,经过及时有效的液体复苏、抗感染、创面处理及多学科综合救治等治疗后,可获得较高的孕妇及胎儿存活率。

Objective To summarize the clinical outcomes of burn patients in different stages of pregnancy and explore a rational therapeutic scheme for burns during pregnancy.Methods A retrospective observational study was conducted.From June 2010 to June 2020,21 patients who met the inclusion criteria were admitted to the Department of Burns of Wuhan Third Hospital and 14 patients who met the inclusion criteria were admitted to the Department of Burns of the First Affiliated Hospital of Nanchang University.Based on the pregnancy period when patients suffered burns,the 35 patients were divided into early pregnancy group with 18 patients(aged(26±4)years,with 8(4,11)weeks of gestation),middle pregnancy group with 10 patients(aged(26±3)years,with 21(14,27)weeks of gestation),and late pregnancy group with 7 patients(aged(30±5)years,with 32(29,35)weeks of gestation).All the patients received treatment including fluid resuscitation,anti-infection,wound treatment,and multidisciplinary comprehensive managements.The burn-related complications during the treatment,maternal outcomes,fetal outcomes,fetal delivery mode,gestational weeks at delivery,and newborn weight of patients in the 3 groups were recorded.Data were statistically analyzed with one-way analysis of variance,Kruskal-Wallis test,and Fisher's exact probability test.Results During the treatment,there were 4,4,and 2 patients who suffered wound infections and 1,3,and 2 patients who developed shock symptoms,respectively,in early pregnancy group,middle pregnancy group,and late pregnancy group.There were no statistically significant differences in them among the 3 groups(P>0.05).One patient in late pregnancy group developed into multiple organ dysfunction syndrome after debridement.At last,all the pregnant women survived,and no statistically significant difference existed among the 3 groups(P>0.05).In early pregnancy group,middle pregnancy group,and late pregnancy group,the survived fetus cases were 9,8,and 6,respectively,and the differences between them were not statistically significant(P>0.05).Variables including stillbirth and full-term birth were close in patients in the 3 groups(P>0.05),while the preterm birth and miscarriage in patients in the 3 groups were statistically different(P<0.05 or P<0.01),with the early pregnancy group having the most miscarriage cases and the fewest preterm birth cases.There were no statistically significant differences in fetal delivery mode,gestational weeks at delivery,and newborn weight among the patients with survived fetus in 3 groups(P>0.05).Conclusions For patients suffering burns during early,middle,and late pregnancy,superior rates of maternal and fetal survival can be achieved after timely and adequate treatments including fluid resuscitation,anti-infection,wound treatment,and multidisciplinary comprehensive managements.