163例老年人烧伤的特点与治疗

目的回顾总结163例老年烧伤发病特点及救治经验。方法从总的比率、性别比、季节、年龄特点、致伤地点、原因、部位、转归、创面处理、补液和抗生素应用等方面阐述老年烧伤的发病规律和治疗经验。结果男68例,女95例,其中146例家中致伤,年龄越大发病危险性越高,部位以下肢等暴露部位常见,对原有疾患要及时治疗并注重老年患者的护理,深Ⅱ°和Ⅲ°创面的患者,宜尽早手术。结论老年人致伤多在家中发生,要重视预防在家中烧、烫伤。     

1701例烧伤患者的流行病学现况分析

[目的]分析一组烧伤患者的发生特点,为制定烧伤干预策略提供科学依据.[方法]统计在湘雅医院烧伤重建外科住院的烧伤患者1 701例,对其年龄、性别、地域来源、烧伤原因、发生季节、烧伤部位、烧伤面积、严重程度、住院天数及治愈情况等进行分析.[结果]①患者年龄:儿童784例(46.1%),其中0～3岁婴幼儿411例(52.4%);25～60岁的患者688例(40.4%),0~7岁儿童患者比例显著高于其他年龄组( P <0.01);②性别:男性1175人(69.1%),女性:526人(30.9%);儿童中男∶女=2.4∶1,男性明显多于女性( P <0.01);③烧伤原因:热力烧伤1444例(84.9%),不同年龄段烧伤原因不同( P <0.01);农村与城市的烧伤原因构成比尚无明显差别;④发生季节:春夏秋冬无明显差别,春季最高,秋季最低;⑤地域来源:来自农村者930例(54.7%),城市771例(45.3%);⑥烧伤部位:全身多部位烧伤(3处以上)者1010例(59.5%),头面颈烧伤215例(12.6%),下肢烧伤182例(10.7%)和手烧伤118例(6.9%);⑦烧伤面积:烧伤面积＞30%TBSA者448例(26.3%),不同烧伤原因所致烧伤面积不全相同( P <0.05);⑧严重程度:严重烧伤患者653例(38.4%),其中特重烧伤395例(23.2%),以热液烫伤和火焰烧伤患者重度烧伤居多( P <0.01);⑨病死率1.5%;⑩住院时间:＞14 d者921例(54.1%),其中≥1个月者360例(15%),≥2个月者105例(6.2%).[结论]儿童烧伤的发生率高,以热力烧伤为主,男性患者明显多于女性,可预防性强,应在不同季节和地域加强烧伤的三级预防工作;本院烧伤患者危重症比例大,应进一步提高护士和其他医务人员对危急重症烧伤患者的救治和烧伤康复的能力.     

1120例小儿烧伤的临床特点分析及预防

目的探讨小儿烧伤的临床特点,以提出针对性的预防措施,减少和防止小儿烧伤发生。方法回顾性分析2004年6月—2009年5月收治的1 120例小儿烧伤住院患者的完整病历资料,包括患儿的年龄、致伤原因、烧伤部位、烧伤发生的月份、地点、家庭及监护人情况等。结果 1 120例小儿烧伤病例中,1～3岁年龄段患儿678例占60.54%,远高于其他年龄段;致伤因素以热液烫伤最多,821例占73.30%;烧伤部位以头面颈部（51.07%）和四肢（70.36%）居多;以冬季（12-2月）和夏季（5-8月）发生居多,分别占27.59%和39.37%;烧伤地点大多发生在家中（83.13%）且有监护人在场（81.61%）;烧伤患儿家庭以农村家庭居多（47.32%）。结论小儿烧伤大多是因为家长的疏忽大意和照顾不周所致,多发生在1～3岁年龄段,以热液烫伤为主且有明显的高发季节,发生地点多在家中且有监护人在场,以农村家庭居多。因此,提高家长的安全意识和对容易致伤的物品妥善放置、管理,是减少和防止小儿烧伤的最有效的措施,加强科学卫生知识的宣传教育,为小儿提供一个安全、健康的活动场所。     

成批烧伤院外救治不足78例分析

198 6年至今 ,我们共救治了 18批 375例烧伤患者 ,其中 6批 78例院外救治中存在问题和不足 ,分析如下。1　临床资料本组男 5 1例 ,女 2 7例 ,烧伤面积 7%～ 82 % (平均 5 8% ) , 度烧伤面积 1%～ 5 4 % (平均 31% ) ,伴有吸入性损伤 73例 ,占 93.6 %。致伤原因 :火焰烧伤 2批 ,天然气爆炸烧伤 1批 ,汽油烧伤 1批 ,瓦斯爆炸烧伤 1批 ,火药爆炸烧伤 1批。死于吸入性损伤 4例 ,死于全身脓毒症 4例 ,死于高钠血症 3例。2　讨论2 .1　现场救治力度不够　由于事故多发生于专州地县 ,甚至远离县城几十公里的地方 ,最先到达现场的多为当地医务人员 ,…     

小儿烧伤后并发惊厥的护理

目的：对小儿烧伤后并发惊厥的患者进行观察护理。方法：从978例烧伤患者中选择年龄、入院时间、致伤部位、烧伤面积及烧伤深度等不同,对56例小儿烧伤后并发惊厥的患者进行临床观察及护理。结果：住院期间发生惊厥一次以上者56例,全部治愈。结论：小儿烧伤后,要严密观察病情变化,保持输液及呼吸道通畅,并做好血离子检测,才能更好地防止惊厥的发生。     

儿童烧伤385例的临床分析及预防对策

临床上儿童烧伤较常见 ,烧伤后瘢痕增生、挛缩畸形和功能障碍等有可能伴随小儿终生[1] 。关于儿童烧伤的流行病学研究报道较多[2 ,3] ,其结果不一。现将 1991年 1月至 2 0 0 0年 12月在本院烧伤中心住院的 15岁以下儿童烧伤 385例总结报道如下。1　临床资料1.1　方法　对 385例患儿的年龄 ,性别 ,烧伤面积(ＴＢＳＡ % ) ,致伤原因和损伤部位进行分析。按不同年龄段分四组 :<12个月 ;1～ 2岁 ;3～ 6岁 ;7～ 15岁。烧伤严重程度按烧伤深度与面积 (Ⅱ度 /Ⅲ度 %ＴＢＳＡ)分类 :轻度ＴＢＳＡ <5 % ;中度 5 %～ 15 % / <5 % ;重度 15 %～ 2 5 % /…     

手背深度烧伤早期修复与其功能效果的评价

目的:评价手背深度烧伤早期行切、削痂植皮或皮瓣转移修复后的疗效。方法:于1984-01/2005-12选择泸州医学院附属医院整形烧伤外科手背深度烧伤患者307例586只手为观察对象,诊断明确后立即行焦痂切开减张术,油纱或抗生素纱布填塞包扎,其余创面行暴露疗法,并进行早期切、削痂植皮或皮瓣转移治疗,分析伤后手术时间(≤10d和>10d)与术后近期疗效关系、烧伤面积(≤30%,31%～70%,≥71%)与术后近期疗效关系、术后近期疗效与远期疗效的对比。结果:纳入患者307例,均进入结果分析。①伤后10d内手术者优良率高于伤后>10d手术者(分别为94.6%,80.4%,P<0.05)。②烧伤面积≤30%患者术后近期优良率显著高于烧伤面积31%～70%和烧伤面积≥71%患者(分别为96.1%,90%,83.8%,P<0.001);烧伤面积31%～70%患者术后近期优良率也显著高于烧伤面积≥71%患者(P<0.05)。③术后近期疗效与随访远期疗效均优者占76.5%(140只手),均良者为60.7%(17只手),均差者为73.3%(11只手),两者之间有显著的相关性(P<0.001)。结论:手背深度烧伤早期行切、削痂植皮或皮瓣转移修复有助于患手功能恢复和重建,烧伤面积越大术后指导性功能锻炼对手功能恢复更重要。     

吕梁市小儿烧伤病因调查及预防

选择1991年1月2008年12月收治的3d～14岁烧伤患儿1130例,占同期住院烧伤患者总数的31％,其中男751例,女379例,死亡8例,病死率为0．7％。本文从小儿烧伤的年龄分布,发病季节,烧伤原因,烧伤面积、部位,以及死亡情况进行调查分析,报告如下。     

体位摆放配合早期康复训练对烧伤后足下垂的防治作用

烧伤后足下垂患者20例,致伤原因为热烧伤16例,电接触性损伤4例。烧伤面积为50～98％,踝关节烧伤深度为深Ⅱ°～Ⅲ°。按就诊时间分为2组,①2012年1月～2012年5月收治的10例患者为对照组,男8例,女2例;年龄18～57岁;     

小儿烧伤的护理

小儿发育尚不成熟,一旦发生烧伤时全身反应比成人重,病情复杂,变化快,烧伤面积超过10%就有发生休克的可能。因此,小儿烧伤的护理工作十分繁重,并有其特殊的规律。现将白求恩医科大学三院和内蒙古医学院附属医院对430例小儿烧伤的护理体会,综合报道如下。一、临床资料分析本组病例分类按照1970年全国烧伤会议的分类标准,即:1.轻度烧伤:烧伤面积在10%以下的Ⅱ度烧伤。2.中度烧伤:烧伤总面积在11～30%或     

Pediatric upper extremity burns: outcomes of emergency department triage and outpatient management.

Pediatric upper extremity burns are common. Though current American Burn Association guidelines recommend burn unit referral for burns involving the hands or major joints, many minor injuries are treated in the emergency department (ED) or outpatient setting. Despite the large number of burn patients managed by primary care providers, no large studies have been performed to assess effectiveness. A retrospective 5-year review of the epidemiology and outcomes associated with pediatric upper extremity burns treated at an urban ED was performed. Two hundred sixty-nine patients were identified. The mechanism of burn, percentage of total body surface area (%TBSA) affected, plastic surgery consultations (for wound management recommendations and additional treatment), complications, and surgical interventions were examined. Mechanisms of burn included direct contact (47%), scald (29%), flame (12%), electrical (10%), and friction or chemical (1.5%). Fifty percent of patients suffered from burns over less than 1% TBSA; close to 95% had burns on less than 5% TBSA. Seventy-five percent of patients had second-degree burns, 21% had first-degree burns, and 2% had third-degree burns. Forty patients (15%) had a plastic surgery consult. Seven patients (3%) required skin grafting. Complications occurred in five (2%) patients and included two cases of hypertrophic scarring; two patients with flexor contractures, one case of compartment syndrome requiring fasciotomy, and one late infection. These results suggest that although significant burns are usually cared for in specialized burn centers, the majority of childhood burns to the upper extremity are relatively minor and often treated in the primary care setting. Most patients had small areas of injury and healed without complications. Contact burns are an ever-increasing proportion of childhood burns and should be seemingly preventable. Education to parents and primary care physicians should be reemphasized. It appears that minor upper extremity burns treated by our urban ED staff are handled appropriately and result in favorable outcomes.     

Firefighter burn injuries: predictable patterns influenced by turnout gear

Approximately 100 firefighters suffer fatal injuries annually and tens of thousands receive nonfatal injuries. Many of these injuries require medical attention and restricted activity but may be preventable. This study was designed to elucidate etiology, circumstances, and patterns of firefighter burn injury so that further prevention strategies can be designed. In particular, modification of protective equipment, or turnout gear, is one potential strategy to prevent burn injury. An Institutional Review Board-approved retrospective review was conducted with records of firefighters treated for burn injury from 2005 to 2009. Data collected included age, gender, TBSA, burn depth, anatomic location, total hospital days per patient, etiology, and circumstances of injury. Circumstances of injury were stratified into the following categories: removal/dislodging of equipment, failure of equipment to protect, training errors, and when excessive external temperatures caused patient sweat to boil under the gear. Over the 4-year period, 20 firefighters were treated for burn injury. Mean age was 38.9 ± 8.9 years and 19 of 20 patients were male. Mean burn size was 1.1 ± 2.7% TBSA. Eighteen patients suffered second-degree burns, while two patients suffered first-degree burns. Mean length of hospitalization was 2.45 days. Scald burns were responsible for injury to 13 firefighters (65%). Flame burns caused injury to four patients (20%). Only three patients received contact burns (15%). The face was the site most commonly burned, representing 29% of injuries. The hand/wrist and ears were the next largest groups, with 23 and 16% of the injuries, respectively. Other areas burned included the neck (10%), arm (6.5%), leg (6.5%), knees (3%), shoulders (3%), and head (3%). Finally, the circumstance of injury was evaluated for each patient. Misuse and noncontiguous areas of protective equipment accounted for 14 of the 20 injuries (70%). These burns were caused when hot steam/liquid entered the gear via gaps in the sleeve or face mask. Three patients (15%) received injury due to removal/dislodging of their safety equipment, two patients (10%) suffered their injuries during training exercises when they were not wearing their safety equipment, and the final patient (5%) received burns due to sweat evaporation. Firefighter burn injuries occur to predictable anatomic sites with common injury patterns. Modification and optimization of gear to eliminate gaps that allow steam/hot liquid entry may decrease burn injury. Improving education regarding the use of protective equipment may also be beneficial.     

小儿严重烧伤早期抗休克综合治疗对预后的影响

目的　探讨小儿严重烧伤早期抗休克综合治疗对预后的影响。方法　对 2 0 5例小儿严重烧伤临床治疗资料进行回顾性总结 ,16 1例患者早期进行抗休克综合治疗 (A组 ) ,4 4例患者伤后入院较晚 ,平均在伤后 12小时才获得抗休克综合治疗 (B组 )。比较两组患儿的年龄、烧伤面积与深度、治愈率和并发症。结果　A组与B组比较 ,患者年龄、烧伤面积无明显差异 (P >0 0 5 ) ,A组治愈率明显提高 (P <0 0 1) ,主要并发症明显下降 (P <0 0 5或P <0 0 1)。结论　小儿严重烧伤早期抗休克综合治疗明显提高治愈率 ,减少并发症。     

Analysis of burn injuries in frontal automobile crashes

The purpose of this study was to investigate burn injuries resulting from frontal automobile crashes and to determine the effects of frontal airbags on the incidence of burn injuries. The study included 25,464 individual cases from the National Automotive Sampling System database files for the years 1993 to 2000. Occupants were at a significantly higher risk to sustain a burn injury when exposed to an airbag deployment (1.54%) compared with those who received a burn injury when not exposed to an airbag deployment (0.02%; P = 0.02). In contrast to previous publications, this study found that 1.53% of front seat occupants exposed to an airbag deployment sustained an airbag-induced burn injury. The vast majority of airbag-induced burn injuries were minor (98.7%); however, in cases with no airbag deployment, the burns were often much more serious, including fatal burns (29.6%). Occupant weight, height, sex, seatbelt use, and seat position were all found not to be significant in predicting the risk of airbag induced burn injury, whereas age and crash velocity were found to be significant.     

纳米银与磺胺嘧啶银治疗烧伤创面疗效比较的Meta分析

背景:国内外应用纳米银治疗烧伤创面较为广泛,但临床研究报道多为小样本随机对照研究,缺乏循证医学方面的依据和说服力。目的:对纳米银与磺胺嘧啶银治疗烧伤创面疗效进行系统评价。方法:计算机检索PubMed、Sciencedirect(SD)数据库、重庆维普中文科技期刊全文数据库(VIP,1989/2010)和清华同方数据库(CNKI,1979/2010),收集有纳米银制剂治疗烧伤与磺胺嘧啶银治疗相比较的随机对照实验。评价纳入研究的方法学质量并进行资料提取后,采用RevMan5.1软件进行Meta分析。结果与结论:共纳入8个随机对照实验,包括513例Ⅱ度烧伤患者。Meta分析结果显示:创面愈合时间纳米银治疗组少于磺胺嘧啶银组(P<0.001);第15天创面愈合率纳米治疗组与对照组差异无显著性意义,结果为(MD=7.10,95%CI=-2.29~16.50,P=0.14);纳米银治疗组和磺胺嘧啶银组相比,在减少烧伤创面疼痛方面两者差异有显著性意义(P<0.00001)。提示应用纳米银与应用磺胺嘧啶银相比能明显促进烧伤创面的愈合,对缓解创面疼痛程度优势明显,但尚需大样本高质量随机对照研究去进一步证实。     

老年烧伤原因的调查与分析

目的通过对老年人烧伤的原因进行调查与分析,为预防老年人烧伤提供有效的依据。方法调查分析2000年1月-2009年6月收治的270例60岁以上老年烧伤住院患者的致伤因子、好发年龄、烧伤月份、烧伤程度、烧伤地点、家庭及居住情况。结果 270例老年烧伤中,致伤因子以火焰烧伤最多占147例（54.44%）,与其他的致伤因子比较有统计学意义（P〈0.05）;好发年龄以60～69岁年龄段发生率最高占153例（56.67%）,与其他年龄段比较有统计学意义（P〈0.05）;老年烧伤一年四季均可发生,但以寒冷的冬季12月-次年2月居多,占158例（58.52%）,与其他季节比较有统计学意义（P〈0.05）;烧伤程度以轻度为主共142例（52.59%）;烧伤地点大多发生在家中共213例（78.89%）,且为独居占191例（70.74%）;老年烧伤家庭以农村家庭居多共208例（77.04%）。结论随着老年人群逐步增加,烧伤发生率也增高,在日常生活中应采取有效防范措施,防止和减少老年烧伤的发生。     

Cement-related injuries: review of a series, the National Burn Repository, and the prevailing literature.

The spectrum of cement-related injuries encompasses contact dermatitis, abrasions, ulcerations, chemical burns, and burns from explosions during the manufacturing process. The purpose of this study was to compile cement-related conditions seen in two burn units (1999-2005), literature case reports and series (1950-2006) and the (1989-2001) National Burn Repository (NBR). There were 3597 admissions in two Midwestern burn units, of which 12 cases (0.8%) were cement burns. They occurred in men, aged 15 to 64 years with a burn range of 0.25 to 10% TBSA, exposure time of 1 to 6 hours, treatment delay of 1 day to 2 weeks, hospitalization (2-14 days). Literature review of 109 cases indicated that cement-related injuries were predominantly seen in men, aged 26 to 45 years; with a cement-exposure time of 1.5 to 4 hours, treatment delay (1 day to 5 weeks), hospitalization (10-33 days), and healing time (2-7 weeks). There were 52,219 burn admissions in the NBR, of which 44 (0.08%) were cement-related burns; 95% were men with a mean age of 41 years, 6% TBSA cement burn and an 8-day hospital stay. The demographic characteristics of the burn units and NBR cases were similar to those in the literature. This preventable injury occurred primarily in the working age male patient and was associated with long healing times. Public awareness and enhanced manufacturer package warnings and education may decrease future cement-related injuries.     

牛羊膜联合应用rb-bFGF对Ⅱ度烧伤创面的疗效

目的观察牛羊膜覆盖烧伤创面联合应用牛碱性成纤维细胞生长因子（rb-bFGF）对烧伤创面的临床治疗效果。方法选择以Ⅱ度烧伤创面为主的中小面积热力烧伤病人43例,试验创面面积为1%～2%。将每例病人相同性质的创面等分为3份,分别应用有孔牛羊膜（治疗组）、牛羊膜（对照组1）、凡士林油纱布（对照组2）覆盖烧伤创面,3组均联合应用rb-bFGF。结果治疗组与对照组1和对照组2相比,以深Ⅱ度烧伤创面为主的病人的创面愈合时间明显缩短（F=25.36,q=7.25、3.46,P〈0.01）;在治疗以浅Ⅱ度烧伤创面为主的病人过程中,治疗组与对照组2相比创面愈合时间明显缩短（F=12.29,q=5.21,P〈0.01）,而与对照组1相比没有明显差别（q=2.60,P〉0.05）。结论有孔牛羊膜覆盖烧伤创面及联合应用rb-bFGF能加速烧伤创面的愈合。     

高密度脂蛋白对严重烧伤大鼠肝组织保护的组织学观察

目的：探讨高密度脂蛋白（HDL）对严重烧伤大鼠肝脏的保护作用。方法：制作大鼠30％体表Ⅲ度烫伤模型，观察正常对照组（不作任何处理），烧伤组（烫伤后30min补充平衡溶液）及实验组（烫伤后立即静脉注入HDL）。伤后12、24、48、72h4个时间点的肝组织学变化和细胞间粘附分子1（ICAml）的表达。结果：（1）组织学观察：烫伤后各组大鼠肝细胞均有不同程度损伤，其中以烧伤组伤后24h最重，肝窦扩张充血，窦内炎细胞浸润，肝细胞变性，点灶性坏死，实验组24h肝组织学改变与烧伤组比较上述损伤明显改善。正常对照组肝组织结构基本正常。（2）ICAm-1免疫组化检测：正常对照组无表达，烧伤组与实验组ICAm-1平均表达率分别为81．6％（49／60）及36．6％（22／60），两组24h时段的表达率分别为86．6％（13／15）及20％（3／15），烧伤组表达强度明显高于实验组（P〈O．01），而两组各其他时段表达强度差异无显著性（P〉0．05）。结论：严重烧伤大鼠早期应用HDL对抑制肝细胞中ICAm-1的表达，减少肝细胞免疫损伤有良好的效果。