成批中重度烧伤患者长途转送后的救治

Treatment of severely burned patients transferred from remote areas after mass casualties

目的:分析成批危重烧伤患者长途转运后并发症及总结其救治经验。方法:两批烧伤中的重度烧伤患者13名,分别于伤后3 d和4 d由外地长途空运转入,烧伤面积75％±25％,Ⅲ度烧伤面积63％±34％且有中度吸人性损伤;入院时所有患者已出现创面溶痂,大部分患者分别或同时有休克、严重高钠血症、白细胞总数低、低蛋白血症、应激性溃疡出血等并发症。治疗措施包括:①入院后尽快行相关检查,掌握病情;尽快处理休克和严重高钠血症等危及生命并发症。②尽快手术封闭创面。③加强抗感染治疗的同时,积极实施器官功能及免疫支持。结果:入院后并发症得到迅速纠正,大部分患者顺利恢复。5例Ⅲ度烧伤面积≥95％患者伤后2周左右始出现脓毒症和器官功能不全。经积极对症处理和器官支持等治疗3例治愈,2例分别因自体皮极度匮乏和急性乙型肝炎而死亡。结论:成批烧伤中的危重患者长途转运后极易出现危及生命的并发症;掌握并发症发生特点并及早处理是成功救治的关键。

Objective:To analyze the treatment of life-threatening complications of severely burned patients transferred from remote areas after mass casualties. Methods; 13 patients injured in 2 mass casualties were transferred to our burn institue 3-4 days after the injury. The mean burn area was 75% TBSA, in which a mean of 63% TBSA were full-thickness burns. All of them had escar lysis, and most of them manifested hypovolemic shock, hypernatremia, leucopenia, hypoproteinemia, and stress ulcer separately or simultaneity on admission. Physical and laboratory examinations were performed on admission to define life-threatening complications. Hypovolemic shock was treated under Swan-Gans catheter monitoring, and hypernatremia was treated with heparin-free hemodialysis as soon as the diagnosis was established. Escharectomy and micro-skin and allgraft transplantation were performed as soon as the general condition was stabilized, average about 3-5 day after burns. Broad-spectrum antibiotics were also used and systemic support measures including immunomodulation were taken. Results;Most patients recovered smoothly. Five patients whose burned areas were over 95% TBSA developed other complications as sepsis and organ disfunction about 2 weeks after the injury, and 3 of the 5 patients were cured and the other 2 patients died of wound sepsis due to lack of donor site and acute hepatitis B respectively. Conclusion;Those patients who were severely burned in mass casualties, and were transferred from remote areas in relatively early stage after the injury, were usually complicated by life-threatening morbid states on admission. When the wounds could not be totally covered due to lack of donor area, severe sepsis would occur about 2 weeks after the injury and result in death. Be cognizant of those complications and treat them properly as early as possible were the key to save the patients.