摘要
目的 探讨吸入性损伤流行病学特点,总结喉烧伤诊断标准的临床应用经验. 方法 收集笔者单位1999年1月-2013年6月收治的443例吸入性损伤患者病历资料.统计患者性别、年龄、吸入性损伤严重程度、合并症及伤前疾病,不同程度吸入性损伤患者的烧伤总面积、Ⅲ度烧伤面积、伤后入院时间及喉烧伤情况,患者治疗及预后情况包括气管切开率、切开时间及并发症、病死率及死亡原因等.对数据行非参数Kruskal-Wallis检验、x2检验,对吸入性损伤严重程度与烧伤总面积、喉烧伤严重程度、气管切开率、病死率的相关性行Spearman相关分析. 结果 （1）本组患者中男353例占79.7％,女90例占20.3％,男女比例约4∶1.小于或等于20岁者64例占 14.4％,大于20岁且小于或等于40岁者203例占45.8％,大于40岁且小于或等于60岁者144例占 32.5％,大于60岁者32例占7.2％.本组患者中轻、中、重度吸入性损伤患者分别为297、108、38例.7例有合并症,21例有伤前疾病.不同程度吸入性损伤患者的烧伤总面积和Ⅲ度烧伤面积均差异明显（H值分别为73.752、142.830,P值均小于0.01）,伤后入院时间差异无统计学意义（H=1.528,P＞0.05）.相关分析显示吸入性损伤严重程度与烧伤总面积呈明显正相关（r=0.399,P＜0.001）.轻度吸入性损伤患者中,轻度喉烧伤占68.0％（202/297）,中度喉烧伤占32.0％（95/297）,重度喉烧伤0例;中度吸入性损伤患者中,轻度喉烧伤0例,中度喉烧伤占53.7％ （58/108）,重度喉烧伤占46.3％ （50/108）喉烧伤情况总体比较差异有统计学意义（x2=336.703,P＜0.001）.相关分析显示喉烧伤严重程度与吸入性损伤严重程度呈明显正相关（r =0.700,P＜0.001）.（2）本组患者总体气管切开率为37.02％（164/443）.轻、中、重度吸入性损伤患者的气管切开率分别为10.44％ （31/297） 、87.96％（95/108）、100.00％ （38/38）,差异明显（x2=271.654,P＜0.001）.相关分析显示气管切开率与吸入性损伤严重程度呈明显正相关（r=0.784,P＜0.001）.本组患者气管切开时间以伤后6 h以内为主占63.4％ （104/164）.气管切开并发症发生率为5.5％（9/164）.（3）本组患者中共31例死亡,病死率为7.00％.轻度吸入性损伤患者病死率为1.01％ （3/297）,中度吸入性损伤患者病死率为12.96％（14/108）,重度吸入性损伤患者病死率为36.84％（14/38）,差异明显（H=74.273,P＜0.001）.相关分析显示病死率与吸入性损伤严重程度呈明显正相关（r=0.371,P＜0.001）.死亡患者的死亡原因中,脓毒症14例占45.2％,呼吸功能衰竭7例占22.6％,呼吸道梗阻2例占6.5％,呼吸道出血2例占6.5％,脑出血2例占6.5％,心脏意外2例占6.5％,中枢性尿崩1例占3.2％,另有1例占3.2％因经济原因放弃治疗自动出院. 结论 吸入性损伤患者中,男性占绝大多数,青中年构成比最高.吸入性损伤严重程度与烧伤总面积、喉烧伤严重程度、气管切开率、病死率相关.利用喉烧伤诊断标准和气管切开指征,可有效避免喉梗阻风险;早期行预防性气管切开手术,有利于降低手术难度和风险.
Objective To explore the epidemiological characteristics of inhalation injury and to summarize the clinical application experience of diagnostic standard of burn of larvnx.Methods Medical records of 443 patients with inhalation injury admitted to our burn unit from January 1999 to June 2013 were analyzed,including gender,age,severity of inhalation injury,complications and diseases before injury; total area and that of full-thickness burn injury,admission time after burn,and burn condition of larynx of patients with different degrees of inhalation injury; treatment and outcome including rate,time,and complication of tracheotomy,mortality,and cause of death.Data were processed with nonparametric Kruskal-Wallis test and chi-square test.The relationship between severity of inhalation injury and total burn area,degree of burn of larynx,tracheotomy rate,and mortality was assessed by Spearman correlation analysis.Results （1） Among the patients,there were 353 （79.7％） male and 90 （20.3％） female,with the ratio of male to female 4∶ 1.There were 64 （14.4％） patients younger than or equal to 20 years,203 （45.8％） patients older than 20 years and younger than or equal to 40 years,144 （32.5％） patients older than 40 years and younger than or equal to 60 years,and 32 （7.2％） patients older than 60 years.The numbers of patients with mild,moderate,and severe inhalation injury were respectively 297,108,and 38.Seven patients suffered from complications,and 21 patients had diseases before injury.There were statistically significant differences among the patients with different degree of inhalation injury in regard to total burn area and fullthickness burn area （with H values respectively 73.752 and 142.830,P values below 0.01）,while no statistically significant difference was observed in admission time after burn （H =1.528,P ＞0.05）.Correlation analysis showed that severity of inhalation injury was positively correlated with total burn area （r =0.399,P ＜0.001）.Among the patients with mild inhalation injury,incidences of patients with mild,moderate,and severe burn of larynx were respectively 68.0％ （202/297）,32.0％ （95/297）,and 0,and those among the patients with moderate inhalation injury were respectively 0,53.7％ （58/108）,and 46.3％ （50/108）.There were statistically significant differences in degree of burn of larynx of patients with different degree of inhalation injury （x2 =336.703,P ＜ 0.001）.Correlation analysis showed that severity of burn of larynx was positively correlated with severity of inhalation injury （r =0.700,P ＜0.001）.（2） The rate of tracheotomy was 37.02％ （164/443）.The rates of tracheotomy in patients with mild,moderate,and severe inhalation injury were respectively 10.44％ （31/297）,87.96％ （95/108）,and 100.00％ （38/38）,x 2 =271.654,P ＜ 0.001.Correlation analysis showed that the rate of tracheotomy was positively correlated with severity of inhalation injury （r =0.784,P ＜ 0.001）.Tracheotomy was done mainly within 6 h post burn （63.4％,104/164）.The incidence rate of complication of tracheotomy was 5.5％ （9/164）.（3） Thirty-one patients died,with a mortality rate of 7.00％.The mortality rates of patients with mild,moderate,and severe inhalation injury were respectively 1.01％ （3/297）,12.96％ （14/108）,and 36.84％ （14/38）,H =74.273,P ＜0.001.It was found that the mortality was positively correlated with severity of inhalation injury （r =0.371,P ＜0.001）.The causes of death of the patients were respectively sepsis （14,45.2％）,respiratory failure （7,22.6％）,airway obstruction （2,6.5％）,airway hemorrhage （2,6.5％）,cerebral hemorrhage （2,6.5％）,cardiac accident （2,6.5％）,and diabetes insipidus （1,3.2％）,and 1 （3.2％） patient quit treatment and discharged from hospital for economic reason.Conclusions Among the patients with inhalation injury,male is dominated in number,and the young adults formed the highest constituent ratio.The severity of inhalation injury was correlated with total burn area,severity of burn of larynx,tracheotomy rate,and mortality.With the guidance of diagnostic criteria of burn of larynx and indication of tracheotomy,the risk of laryngeal obstruction can be eliminated.The early preventive tracheotomy can decrease the difficulty and risk of the operation.
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2014年第5期400-404,共5页
Chinese Journal of Burns
基金
国家自然科学基金（81071550）
关键词
烧伤
吸入性
气管切开术
喉烧伤
Burns, inhalation
Tracheotomy
Burn of larynx
