480例电烧伤并发脑损伤患者流行病学分析

Epidemiological analyses of 480 patients with electrical burn complicated by cerebral trauma

目的探讨不同电压电烧伤并发脑损伤患者的流行病学特点,为提高电烧伤并发脑损伤救治水平提供依据。方法采用回顾性队列研究分析2001年1月至2019年12月青岛大学附属青岛市市立医院诊治的480例电烧伤并发脑损伤患者的临床资料。根据电压强度将患者分为低电压组(致伤电压<1 kV,295例)和高电压组(致伤电压≥1 kV,185例)。统计所有患者性别、年龄及烧伤情况等一般资料。比较两组患者临床表现、意识[格拉斯哥昏迷评分(GCS)]、影像学表现、治疗、预后[格拉斯哥预后评分(GOS)]及并发症。结果(1)性别、年龄:患者男女比例为5.4∶1.0;发病高峰年龄为18~60岁,共302例(62.9%);烧伤情况:烧伤面积为1%~78%[(20.0±4.0)%]总体表面积(TBSA),电流出入口位于头部321例。(2)临床表现:意识障碍占比最高,低电压组295例(100%),高电压组185例(100%);其次是头痛,低电压组178例(60.3%),高电压组115例(62.2%)(P均>0.05)。(3)意识:37例昏迷,其中低电压组17例(5.8%),高电压组20例(10.8%)(P<0.05)。(4)影像学表现:CT、MRI检查发现脑水肿、颅骨骨折、颅内血肿、脑缺血、蛛网膜下腔出血等阳性病变。头部有创面(电流出入口位于头部)患者中,低电压组脑损伤发生率为44.0%,高电压组脑损伤发生率为86.8%(P<0.05)。头部无创面(电流出入口不位于头部)患者中,低电压组脑损伤发生率为5.3%,高电压组脑损伤发生率为6.3%(P>0.05)。对于电流出入口位于头部患者,其脑损伤类型比电流出入口不位于头部脑损伤类型多颅骨骨折、颅内血肿、蛛网膜下腔出血3种。(5)治疗、预后及并发症:非手术治疗478例(99.6%);手术治疗2例(0.4%),死亡1例(0.2%),救治成功479例(99.8%)。低电压组良好280例(94.9%),中残13例(4.4%),重残2例(0.7%);高电压组良好143例(77.3%),中残30例(16.2%),重残11例(5.9%),死亡1例(0.5%)(P均<0.01)。患者出院后,低电压组麻木、感觉异常、焦虑发生率显著高于高电压组(P均<0.01)。结论电烧伤并发脑损伤患者男性多于女性,中青年是高发重点人群。意识障碍和头痛是主要临床表现;高电压昏迷发生率更高;与低电压烧伤相比,高电压烧伤并发脑损伤(电流出入口位于头部)严重程度更明显,范围更广泛;早期积极行CT或MRI检查,有利于明确诊断;非手术治疗是主要治疗方式;与高电压烧伤相比,低电压烧伤并发脑损伤患者预后明显占优,麻木、感觉异常、焦虑并发症更容易出现在低电压烧伤并发脑损伤患者中。

Objective To explore the epidemiological characteristics of patients with electrical burn at different voltages complicated by cerebral trauma,so as to provide a basis for improving the treatment level of such injury.Methods A retrospective cohort study was conducted to analyze the clinical data of 480 patients with electrical burn complicated by cerebral trauma treated in Qingdao Municipal Hospital affiliated to Qingdao University from January 2001 to December 2019.According to the voltage intensity,the patients were divided into low voltage group(injury voltage<1 kV,n=295)and high voltage group(injury voltage≥1 kV,n=185).Gender,age,status of burn and other general data of all patients were collected.The clinical manifestations,consciousness[Glasgow coma scale(GCS)],imaging findings,treatment,prognosis[Glasgow outcome scale(GOS)]and complications were compared between the two groups.Results(1)Gender and age:the male to female ratio was 5.4∶1.0;the peak age of onset occurred at 18-60 years,accounting for 302 patients(62.9%);the status of burn:the burn area ranged from 1%-78%[(20.0±4.0)%]total body surface area(TBSA),with the current outlet located at the head in 321 patients.(2)Clinical manifestations:consciousness disorders accounted for the highest proportion,with 295 patients(100%)in low voltage group and 185 patients(100%)in high voltage group,followed by headache which occurred in 178 patients(60.3%)in low voltage group and 115 patients(62.2%)in high voltage group(all P>0.05).(3)Consciousness:37 patients presented coma,with 17 patients(5.8%)in low voltage group and 20 patients(10.8%)in high voltage group(P<0.05).(4)Imaging findings:CT and MRI examination found cerebral edema,skull fracture,intracranial hematoma,cerebral ischemia,subarachnoid hemorrhage,and other positive lesions.In patients with head wounds(current inlet and outlet located in the head),the incidence of cerebral trauma was 44.0%in low voltage group and 86.8%in high voltage group(P<0.05).In patients with no head wound(the current outlet was not located in the head),the incidence of cerebral trauma was 5.3%in low voltage group and 6.3%in high voltage group(P>0.05).In contrast with the patients without current outlet locating in the head,there were three more types of cerebral trauma in patients with current outlet locating in the head,including skull fracture,intracranial hematoma and subarachnoid hemorrhage.(5)Treatment,prognosis and complications:478 patients(99.6%)received non-surgical treatment and 2 patients(0.4%)received surgical treatment.There was 1 death(0.2%)and 479 successfully treated patients(99.8%).The prognosis was good in 280 patients(94.9%),moderately disabled in 13(4.4%)and severely disabled in 2(0.7%)in low voltage group;while the prognosis was good in 143 patients(77.3%),moderately disabled in 30(16.2%),severely disabled in 11(5.9%)and death in 1(0.5%)in high voltage group(all P<0.01).After discharge,the incidence of numbness,paresthesia and anxiety was significantly higher in low voltage group than that in high voltage group(all P<0.01).Conclusions Male patients with electrical burn complicated by cerebral trauma are more than female patients,with the young and middle-aged population being at high risk.Disturbance of consciousness and headache are the main clinical manifestations.The incidence of high voltage coma is relatively higher.Compared with low voltage-induced electrical burn,the patients with high voltage-induced electrical burn complicated by cerebral trauma(current inlet and outlet located at the head)sustain more severe and extensive injury.Early and active CT or MRI examination is conducive to definite diagnosis.Non-surgical treatment is the main treatment.Compared with high voltage-induced electrical burn,the patients with low voltage-induced electrical burn complicated by cerebral trauma have significantly better prognosis,but are more likely to develop complications of numbness,paresthesia and anxiety.