621例电烧伤住院患者的流行病学调查

Epidemiological investigation of 621 inpatients with electrical burn

目的分析电烧伤住院患者的流行病学特点,为电烧伤的防治提供参考。方法收集2010年1月至2022年12月首都医科大学附属北京积水潭医院收治的所有烧伤住院患者病例资料,对电烧伤住院患者占同期烧伤住院患者总数的百分比、性别、年龄、人群类别、受伤情境、受伤季节、烧伤总面积、烧伤深度、致伤电压、受伤部位、治疗方法、截肢(指、趾)率、住院时间、手术次数、住院费用、治疗结局进行统计分析。结果13年间共收治住院烧伤患者3089例,其中电烧伤住院患者621例,占20.1%,包括电接触伤患者432例(69.6%)、电弧烧伤患者189例(30.4%)。621例患者中男592例,女29例,年龄(35±13)岁,77.62%(482/621)的患者处于21~50岁年龄段。人群类别构成比中居前3位的依次是工人、农民工和中小学生,分别占49.11%(305/621)、33.33%(207/621)和5.64%(35/621)。受伤情境构成比中居首位的是非电力专业工作中,占46.70%(290/621)。受伤季节多为夏季和秋季,分别占42.67%(265/621)和23.99%(149/621)。55.23%(343/621)的患者烧伤总面积<10%总体表面积。高压电接触烧伤患者比例(69.54%)明显高于高压电弧烧伤(15.25%),差异有统计学意义(χ2=62.893,P<0.001)。最常见的受伤部位为上肢(60.49%),之后依次为下肢(16.24%)、头面颈部(11.76%)、躯干(9.72%)及臀会阴部(1.79%)。电烧伤患者手术率为89.86%,明显高于非电烧伤患者的71.31%(χ2=91.078,P<0.001)。176例电接触烧伤患者创面采用吻合血管的游离皮瓣修复,占全部手术电烧伤患者的31.54%。电烧伤患者截肢(指、趾)率为16.91%,其中电接触烧伤患者截肢(指、趾)率为23.15%,明显高于电弧烧伤患者的2.65%,差异有统计学意义(χ2=39.339,P<0.001)。电烧伤患者手术次数为2(1,4)次,住院时间为27(16,45)d,住院费用为75445.00(32213.50,132249.50)元;与电弧烧伤患者相比,电接触烧伤患者手术次数、住院时间和住院费用明显增高(P<0.001)。结论电烧伤住院患者男性多于女性,青壮年工人、农民工可能是预防电烧伤的重点人群;加强用电安全的教育、宣传和管理,以及用电环境周边的警示及保护尤为重要,特别是在夏秋季节。早期积极进行清创,应用吻合血管的游离皮瓣及各类带丰富血运的组织瓣修复创面,可能使电烧伤患者有所获益。

Objective To investigate and analyze the epidemiological characteristics of inpatients with electrical burn in Beijing Jishuitan Hospital(authors’unit),and further to provide reference guide for the prevention and treatment of electrical burn.Method The medical records of inpatients suffered from burns and electrical burns in authors’unit from January 2010 to December 2022 were collected.The patients’gender,age,population category,injury context,injury season,total body surface area(TBSA),depths of wounds,electrical voltages of injury,sites of wounds,treatment method,amputation rates,hospital length of stay,hospitalization expenses and treatment outcome were collected and statistical analyses were performed.Result During the 13 years,3089 burn patients were admitted.Among them,621 patients(20.1%)with electrical burn.There were 432 patients(69.6%)with electrical contact burns and 189 patients(30.4%)with electrical arc burns.Among them,592 were male and 29 were female,the mean age was(35±13)years old,and 77.62%(482/621)of patients were 21-50 years old.The top three groups in population category were workers,peasants and students,and the proportion was 49.11%(305/621),33.33%(207/621)and 5.64%(35/621),respectively.The non-electric professional jobs ranked thefirst in the proportion of injury context,which composed 46.70%(290/621)of all victims.The injury occurs mostly in summer 42.67%(265/621)and autumn 23.99%(149/621).There were 55.23%(343/621)of the patients with burn area less than 10%TBSA.The percentage of high-voltage electrical contact burn patients was 69.54%,which was obviously higher than 15.25%of the electrical arc burn patients(χ2=62.893,P<0.001).The most common wounds site of electrical burn patients was upper limbs(60.49%),followed by lower limbs(16.24%),head and neck(11.76%),trunk(9.72%),hip and perineum(1.79%).The operation rate of electrical burn patients was 89.86%,obviously higher than 71.31%of the nonelectrical burn patients(χ2=91.078,P<0.001).Wounds of 176 electrical contact burn patients were repaired with freeflap by vascular anastomosis,which was 31.54%in the operation rate of electrical burn patients.The total amputation rate was 16.91%,the amputation rate of electrical burn patients was 23.15%,obviously higher than 2.65%of the electrical arc burn patients(χ2=39.339,P<0.001).The number of operations,hospital length of stay,hospitalization expenses of electrical burn patients were 2(1,4),27(16,45)d,75445.00(32213.50,132249.50)Yuan.Compared with those of electrical arc burn patients,the number of operations,hospital length of stay,hospitalization expenses were obviously higher than those of electrical contact burn patients(P<0.001).Conclusion Men are more likely than women to suffer from electric burns in authors’unit.Young workers and peasants may be the important people to prevent electric burns.It is very important to strengthen the management of electric safety education for people and to warn and protect the surrounding area of electric environment,especially in summer and autumn.The patients with electric burn may benefit from early and active debridement,and using tissueflaps including freeflap to repair of wounds.