Burn wound infections

Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.     

10岁以下住院烧伤儿童的临床分析

目的了解10岁以下儿童烧伤住院的特点,为儿童烧伤的预防与控制提供科学依据。方法收集部队医院2007年收治的10岁以下烧伤住院儿童病例资料,对其烧伤原因、发生时间、年龄、伤情等信息进行分类进行回顾性统计分析。结果共收治了10 163例10岁以下烧伤患儿,男女比例为1.69？1,5岁以下儿童烧伤占86.9%,其中1岁年龄段的占40.3%;5月份发生率最高,占10.1%;致伤因素多为热液烫伤,占85.9%;3岁以下年龄组中重度烧伤所占比例高于5岁以上各组（P〈0.05）。结论应加强对4岁以下儿童的监护和看管,加强对儿童生活环境的烧伤安全意识和措施的提高,从多方面入手预防儿童烧伤的发生。     

Stimulation of hematopoiesis by the Fms-like tyrosine kinase 3 ligand restores bacterial induction of Th1 cytokines in thermally injured mice

Patients with large burn injuries are susceptible to opportunistic infections due to impaired functions of multiple effector cells of innate immunity and acquired immunity, including macrophages, dendritic cells (DC), natural killer (NK) cells, and T cells. The ability of a host to produce Th1 cytokines, such as gamma interferon (IFN-gamma) and interleukin-12 (IL-12), upon infectious challenge is also impaired after burn injury. Stimulation of hematopoiesis, to regenerate new immune cells, may be an effective strategy for improving resistance to infections after severe burn trauma. Fms-like tyrosine kinase 3 ligand (Flt3L) is a hematopoietic cytokine that stimulates the expansion and differentiation of NK cells and DC. Using a mouse model, we tested the hypothesis that Flt3L treatments after burn injury stimulate the production of functional effector cells of innate immunity and restore appropriate Th1 cytokine responses to Pseudomonas aeruginosa, a common source of pneumonia and wound infections in burn victims. Flt3L increased splenic cellularity in sham (uninjured) and burned mice and increased the numbers of NK cells (DX5(+)) and DC (CD11c(+)). In response to P. aeruginosa, significant increases in the serum IFN-gamma levels and the numbers of splenic IFN-gamma-producing DC, NK cells, and T cells were observed in Flt3L-treated burned mice compared to the values obtained for untreated burned mice. The splenic levels of IL-12 and IL-15 mRNAs and the IL-12 and IL-15 receptors were also increased. In addition, Flt3L treatment restored the ability of splenic cultures prepared from burned mice to produce IFN-gamma and IL-12 after in vitro challenge with P. aeruginosa. Flt3L may have potential for restoring NK cell and DC functions and improving immunity after burn injury.     

Serum CD14 levels in polytraumatized and severely burned patients.

Recently it has been demonstrated that the CD14 molecule which is expressed on monocytes and macrophages serves as a receptor for lipopolysaccharide (LPS) bound to LPS-binding protein (LBP) and thus mediates LPS-induced tumour necrosis factor (TNF) production. Here we report that CD14 is found as a soluble (s) molecule in serum. In healthy volunteers sCD14 levels (mean +/- s.e.m.) were 3.7 +/- 0.05 micrograms/ml (n = 30, 25-50 years of age) as determined by ELISA (detection limit 20 ng/ml serum) using two monoclonal antibodies in a sandwich technique. In polytraumatized patients (n = 16) significantly decreased levels (1.7 +/- 0.3) were detected immediately after the trauma, which increased to 4.9 +/- 0.3 micrograms/ml within the first 6 days post trauma. sCD14 remained elevated during the first 14 days post trauma in patients with the most severe injuries (injury severity score greater than 45 points), whereas a return to normal levels was observed in patients with an injury score of less than 45 points. In addition, the levels of the high-density lipoproteins that partially inactivate free endotoxin are significantly decreased post trauma. No correlation between parameters of inflammation (C3a and neopterin levels, leucocyte counts, amount of band cells), liver function and sCD14 levels was established. Comparable to polytraumatized patients, increased sCD14 serum levels were observed in five patients with burn trauma (burned area greater than 35%) within the second week post trauma when clinical signs of septicaemia were evident.     

Experimental candidiasis after thermal injury.

The ability of Candida albicans to infect thermally injured mice was studied. Female mice were either left unburned or given a 20% total body surface area 2-s or 7-s scald burn. The wound or skin surface was then inoculated with a human burn wound isolate of C. albicans. At 4 h postburn, approximately 10(2) to 10(3) CFU/g of tissue could be recovered from the skin of burned and unburned animals. Unburned mice cleared the organisms from the skin by 72 h, whereas in 7-s-burned animals, the candida increased in numbers to approximately 10(7) CFU/g of tissue. The ability of the organisms to invade systemically after wound surface inoculation was examined in mice given either a 2-s or a 7-s scald burn. Each injury was histologically confirmed as a full-thickness (third degree) burn, with slightly deeper tissue damage observed with the 7-s burn. At each time period examined (1, 4, 7, and 10 days), there were significantly fewer organisms in the wounds of mice given the 2-s injury than in wounds of mice burned for 7 s (P less than 0.05). In 3 of 33 mice given a 7-s injury, organisms were recovered from the kidneys at the time of sacrifice, whereas no evidence of invasion into the kidneys was noted in mice given a 2-s thermal injury. This study demonstrated that thermal injury enhances the ability of C. albicans to infect mice and that the depth of burn appears to be an important factor in determining whether the organisms can invade the burn wound to cause systemic infection. This animal model should be valuable in elucidating the virulence factors of C. albicans that play a role in the pathogenesis of candidiasis after thermal injury.     

吸入性损伤患者气管切开指征的探讨

目的 气管切开术是挽救合并吸入性损伤的重度烧伤病人的重要和关键方法，本文试图寻找到进行这种手术的最佳时机。方法 观察了本院从1996年1月至2006年12月间收治的153例吸入性损伤病人。就气管切开的指征进行了总结，以便提高吸入性损伤的抢救成功率。结果 正确掌握吸人性损伤气管切开的指征，及时进行气管切开术会提高吸入性损伤患者生存率，对于危重烧伤患者的救治有重要意义。结论 选择最佳的气管切开术实施的时间对挽救大多数烧伤病人至关重要。     

Cadaveric skin allograft-associated cytomegalovirus transmission in a mouse model of thermal injury.

As a routine procedure to provide temporary coverage for burn wounds, cadaveric skin allografts have been used in patients with massive thermal injuries. In this study, CMV infection associated with skin grafting was investigated. Graft-associated CMV transmission was shown in a mouse model of thermal injury. Skins from mice 100 days after a nonlethal dose of murine CMV (MCMV) infection contained MCMV DNA and mRNA, although the virus was not isolated from these murine skins. When these skins were grafted to burned mice, the marked growth of MCMV was demonstrated in salivary glands. No viral growth was shown in the salivary glands of unburned mice or CMV sero(+) mice after grafting with these skins. When severe combined immunodeficient beige (SCID-beige) mice were used as recipients for CMV sero(+) skins, all mice died within 30 days after the grafting. Only 1 PFU/mouse of MCMV was shown to be 1 LD(50) in SCID-beige mice, while a 50% mortality rate was shown in normal unburned mice infected with 5 x 10(5) PFU/mouse of MCMV. This indicates that a very small amount of CMV contained in skins is sufficient to induce CMV infection in immunocompromised hosts. On the other hand, human CMV (HCMV) DNA and mRNA were detected by PCR analysis in 55% (DNA) and 33% (mRNA) of cadaveric skins, although the isolation of HCMV from cadaveric skin homogenates was not achieved in tissue cultures. CMV sero(-) patients with severe burn injuries may have a high risk for CMV infection associated with allografts of cadaveric skins.     

The increased potential for the production of inflammatory cytokines by Kupffer cells and splenic macrophages eight days after thermal injury

Burn patients often experience a devastating inflammatory response to infection within the first two weeks after thermal injury. The inflammatory cytokines IL-6, TNF and IL-1 have been implicated in this condition but most studies have focused on the abnormal levels of cytokines in the plasma. In this study the production of cytokines was compared for Kupffer cells versus splenic macrophages; endotoxin (LPS) stimulation versus no stimulation; and burn (post burn days 1, 3 and 8) versus no burn (control). Corresponding serum levels of IL-6 were also determined. Kupffer cells from normal or burned animals were shown to produce much higher amounts of the inflammatory cytokines than that produced by splenic macrophages. An exception to this was the equal production of TNF by LPS-stimulated hepatic and splenic cells. Both LPS-stimulated Kupffer cells and splenic macrophages produced larger amounts of the cytokines than that produced by the unstimulated cells. There was a significant effect of thermal injury on cytokine production by LPS-stimulated Kupffer cells at post burn day 8 and on TNF production by stimulated splenic macrophages also at post burn day eight. Although there was a statistically significant effect of thermal injury at post burn day 8 on IL-1 production by unstimulated splenic macrophages, the absolute amount of cytokine produced was very small. The results suggest that by post burn day 8 the cells may have become primed to respond to a stimulus such as endotoxin (LPS), a condition that could arise in a burn patient from sepsis. Strangely, the large spike in serum IL-6 level occurred at post burn day one and the level of the cytokine returned nearly to the control value on post burn days 3 and 8.     

Autologous and allogeneic mixed-lymphocyte responses following thermal injury in man: the immunomodulatory effects of interleukin 1, interleukin 2, and a prostaglandin inhibitor, WY-18251

A group of 30 burn patients with 36-87% total body surface area (TBSA) burns was studied at 24-48 hr postburn. These included studies of (1) autologous and allogeneic mixed-lymphocyte reactions (MLR); (2) the immunoregulatory influence of mitomycin C-treated T cells, non-T cells, and unfractionated peripheral blood lymphocytes (PBL) on allogeneic MLR; and (3) correlation between the proportions of T-cell subsets defined with monoclonal antibodies (OKT4 and OKT8) and autologous MLR. Studies concerning adherent cell production of thromboxane, prostaglandin E2, and prostaglandin F2a and the immunomodulatory effects of Interleukin 1 (IL-1), Interleukin 2 (IL-2), and a prostaglandin inhibitor, WY-18251, on autologous MLR are presented. The autologous mixed-lymphocyte reaction was depressed in 60% of the burn patients tested. This depressed response correlated closely to the extent of third-degree injury (P less than 0.025) and to TBSA injury greater than 60% (P less than 0.025). A linear correlation was observed between the depression in autologous MLR and a decrease in both the percentage of OKT4+ T cells and the OKT4+/OKT8+ ratio. The response of T cells from burn patients in allogeneic MLR was normal. Age, sex, TBSA of the burn, and size of second-degree burn did not correlate with the abnormalities observed in MLR. Mitomycin C-treated mononuclear cells, purified T cells, or non-T cells from burned patients did not demonstrate any suppressive influence on MLR in normals. Monocyte number and arachidonic acid metabolism were investigated. In addition to increased numbers of monocytes following thermal injury, adherent cells produced increased quantities of thromboxane, prostaglandin E2, and prostaglandin F2a. The effects of Interleukin 1, Interleukin 2, and a prostaglandin inhibitor, WY-18251, were studied in autologous MLR (AMLR) of burned and normal patients. Interleukin 1 and WY-18251 did not induce any significant changes in proliferation in burned patients or normal controls. When compared to cultures without exogenous IL-2, an increase in AMLR was observed following the addition of IL-2 to burn patient cultures at Day 6 and Day 7 of culture. Although the addition of IL-2 did increase proliferation in AMLR of normal controls at Day 6 and Day 7, the enhancement observed for the burn patient cultures represented a restoration to the level of normal control cultures without IL-2. A dose-dependent increase in AMLR was observed in T cells isolated from normal and burned patients in the presence of purified Interleukin 2.(ABSTRACT TRUNCATED AT 400 WORDS)     

Effect of early body image dissatisfaction on subsequent psychological and physical adjustment after disfiguring injury

OBJECTIVE: The impact of body image dissatisfaction on quality of life after severe burn injury was investigated after controlling for other determinants of outcome (i.e., injury, distress, and preburn quality of life). METHODS: The postburn quality of life (2-months postdischarge) of groups with and without body image dissatisfaction was studied after controlling for preburn quality of life (measured 2-3 days postadmission). The patient population (N = 86) was 77.9% men, had an average total body surface area burned of 17.02%, and average full-thickness burn of 6.09%. Forty percent had facial injuries, 68.6% required surgery, most were injured by flame (39.5%), and 76.8% were employed. RESULTS: Multivariate analysis of covariance (covarying preburn level of Mental quality of life, facial injury, and size of burn) contrasting body image dissatisfaction groups found significantly lower psychosocial adjustment at 2-month follow-up in those with greater body image dissatisfaction (multivariate F = 3.61; p<.01). A second MANCOVA (covarying the preburn level of Physical quality of life and both facial injury and size of burn) found significantly lower physical functioning at 2-month follow-up in those with greater body image dissatisfaction (multivariate F = 2.78; p < .03). Adding two more covariates (depression and posttrauma distress) eliminated the effect of body image dissatisfaction on postburn Physical but not Mental adjustment. CONCLUSIONS: Body image dissatisfaction affects quality of life after severe burn injury. Distress moderates this impact on aspects of physical but not psychosocial health.     

重度烧伤患者中心静脉导管细菌定植分析

目的分析重症烧伤患者发生中心静脉导管细菌定植的原因并探讨其防治措施。方法收集广州市红十字会医院烧伤整形科2005年1月至2007年4月重症烧伤患者行中心静脉置管的相关临床资料，对比导管细菌定植（CAC）的发生率。结果重度烧伤患者中心静脉导管细菌定植发生率为55．56％，明显高于文献报道的其他危重患者的发生率26．3％。不同置管部位，是否经过创面以及置管时间是否大于两周的导管细菌定植发生率差异无统计学意义（P〉0．05）。结论重度烧伤患者中心静脉导管细菌定植的高发生率与创面感染不易控制、导管留置部位多在股静脉、导管经创面留置、留置时间过长等因素有关。多方面的干预才能减少导管相关性感染（CRI）的危险性。     

Quantitative assessments of burn degree by high-frequency ultrasonic backscattering and statistical model

An accurate and quantitative modality to assess the burn degree is crucial for determining further treatments to be properly applied to burn injury patients. Ultrasounds with frequencies higher than 20 MHz have been applied to dermatological diagnosis due to its high resolution and noninvasive capability. Yet, it is still lacking a substantial means to sensitively correlate the burn degree and ultrasonic measurements quantitatively. Thus, a 50 MHz ultrasound system was developed and implemented to measure ultrasonic signals backscattered from the burned skin tissues. Various burn degrees were achieved by placing a 100 °C brass plate onto the dorsal skins of anesthetized rats for various durations ranged from 5 to 20 s. The burn degrees were correlated with ultrasonic parameters, including integrated backscatter (IB) and Nakagami parameter (m) calculated from ultrasonic signals acquired from the burned tissues of a 5 × 1.4 mm (width × depth) area. Results demonstrated that both IB and m decreased exponentially with the increase of burn degree. Specifically, an IB of -79.0 ± 2.4 (mean ± standard deviation) dB for normal skin tissues tended to decrease to -94.0 ± 1.3 dB for those burned for 20 s, while the corresponding Nakagami parameters tended to decrease from 0.76 ± 0.08 to 0.45 ± 0.04. The variation of both IB and m was partially associated with the change of properties of collagen fibers from the burned tissues verified by samples of tissue histological sections. Particularly, the m parameter may be more sensitive to differentiate burned skin due to the fact that it has a greater rate of change with respect to different burn durations. These ultrasonic parameters in conjunction with high-frequency B-mode and Nakagami images could have the potential to assess the burn degree quantitatively.     

Blocking TRAIL-DR5 signaling with soluble DR5 alleviates acute kidney injury in a severely burned mouse model

Acute kidney injury (AKI) predicts high mortality in severely burned patients. Apoptosis plays a significant role during AKI; however, the apoptotic mechanisms underlying AKI induced by burn injury are not clear. Here, we report a critical role for tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL)-Death receptor 5 (DR5) signaling in the pathogenesis of AKI. C57BL/6 male mice were subjected to full thickness scald burn. Apoptosis was significantly up-regulated in mouse kidney 24 h after the burn. Meanwhile, the TRAIL and DR5 expression levels were significantly increased in the kidney 24 h after the burn. Soluble DR5 treatment reduced apoptotic cell death and alleviated kidney injury induced by the burn through blocking the interaction of endogenous TRAIL with DR5. These results demonstrated that TRAIL plays a deleterious role in AKI pathogenesis induced by scald burns. Inhibition of TRAIL function in the kidney may represent a novel protective strategy to treat AKI in patients with burns.     

2010年至2018年北京市某烧伤中心化学性烧伤流行病学特征分析

目的回顾性研究北京市某烧伤中心化学性烧伤流行病学特征。 方法以2010年1月至2018年12月入住北京积水潭医院烧伤科的化学性烧伤患者为研究对象，对患者的性别、年龄、职业、致伤地点、致伤性质和致伤物的类型进行分析。同时研究化学性烧伤不同季节发生率、伤后应急处理情况、烧伤面积、烧伤部位、并发症、手术类型、住院时间和病死率。 结果2010年1月至2018年12月共有456例患者入院。男328例，女128例。大多数患者年龄为21～40岁，占所有患者的74.6%(340/456)。在职业方面，273例(59.9%)患者是工人。大多数化学性烧伤[92.8%(423/456)]发生在远离居住地的地点，在工作环境中受伤的患者[70.4%(321/456)]最多。意外事故和故意伤害导致的化学性烧伤分别为383例(83.3%)和73例(16.7%)。强酸[62.9%(287/456)]是最常见的致伤因素。化学性烧伤的发生率与季节之间存在关联，4月至6月和7月至9月的患者人数较多。77.2%(352/456)患者的烧伤面积小于10%总体表面积(TBSA)。头部[24.6%(112/456)]和四肢[下肢为24.1%(110/456)、上肢为28.7%(131/456)]是最常见的受伤区域。最常见的并发症是眼烧伤[13.8%(63/456)]。其中243例(53.3%)患者进行了植皮手术和结膜自体移植手术。患者的平均住院时间为(34±2) d。本研究中仅有4例(0.9%)患者因化学性烧伤而死亡。 结论化学性烧伤多发生于男性青壮年，工作中受伤最多，大多数是意外导致的。受伤季节多发生于夏、秋季，大多数烧伤面积较小，头部和四肢多见，并发症以眼烧伤多见。建议为工人制定专业培训计划，以降低化学性烧伤的发生率。     

Kinetics of lymphoproliferative responses following scald injury in a rat burn model

Splenic lymphocytes from scalded and nonscalded rats were studied for their proliferative response to phytohemagglutinin, and to allogeneic cells in a one-way mixed lymphocyte culture (MLC). A significant suppression of the proliferation of lymphocytes in both these assays was observed as early as 4 days postinjury as measured by the [3H]thymidine uptake studies. The lymphocyte response to PHA returned to normal levels by Day 21 postinjury, whereas the MLC responses continued to be suppressed. The MLC responses between nonburned and burned animals could be restored by the addition of a lymphokine-rich culture supernatant obtained from concanavalin A-activated lymphocytes from normal nonburned rats, as well as by the addition of purified human interleukin 2 (IL-2) and rat interleukin 2. However, the addition of purified human interleukin 1 and human interferon gamma (Hu-IFN-gamma) did not bring about a significant change in the proliferation of burned rat spleen cells in MLC. Cells from burned rats were also tested for the development of suppressive activity by adding splenic lymphocytes from 2-week postburn rats to an ongoing one-way MLC. The addition of lymphocytes from burned rats resulted in significant suppression (81%) of MLC responses among normal nonburned rats. The data suggest that the development of suppressor cells following burn injury along with a defect in production and/or uptake of IL-2 may be partly responsible for immune suppression following burn injury. Since the proliferative response of lymphocytes from thermally injured rats is suppressed in a similar fashion as that found in thermally injured patients, the rat appears to be a good model for the study of kinetics of immune suppression following burn injury.     

严重烧伤回吸收期液体治疗的探讨

烧伤回吸收期的补液如何进行,尚未有一个为广大临床工程师所接受的方案.为此,本文作者对本院救治的103例严重烧伤病人进行了回顾性研究,认为对严重烧伤病人在此阶段的补液.除生理需要量外,至少应保持在53ml/1%BSA/d,方能补充其失水量.从而提出本作者的观点,以探讨此阶段的补液问题.     

Primary immune response to blood group antigens in burned children

Delayed hemolytic transfusion reactions (DHTRs) are generally attributed to an anamnestic immune response. Case reports of DHTRs due to a primary immune response are rare. Transfusion reactions occurring in patients on the pediatric burn unit from 1981 to September 1988 were reviewed, and additional information was obtained for patients for whom a DHTR was documented. Of 62 transfusion reactions, 11 were classified as a primary immune response (DHTR), with either a positive antibody screen, a positive direct antiglobulin test (DAT), or both. None of the 11 patients included in the study had been previously tranfused or pregnant. The average number of units transfused prior to antibody identification was 19. The average time elapsed between the first transfusion and antibody identification was 3.6 weeks. Anti-K and anti-E were the most frequently identified. Three patients had a decrease in hemoglobin (average 1.5 g/dL) and hematocrit at the time that a positive DAT was detected. Such changes could not be demonstrated for the remaining eight patients. The conclusion was that a DHTR may he caused by a primary immune response in burned children more often than expected, but DHTR signs and symptoms are often not apparent due to the complications of burn trauma.     

Acute respiratory insufficiency in burn patients from smoke inhalation

Respiratory injuries by smoke inhalation are one of the most frequent reasons for acute respiratory failure in burn victims. They are most often of chemical origin and are responsible of a 20 to 70% increase of the mortality compared to the mortality of patients with similar burn injuries, but without inhalation lesions. They are often associated to a certain degree to other factors of acute respiratory failure: superior air way obstruction by oedema in face and neck burns, thoracic expansion hindrance due to thoracic burns, lung trauma lesions by blast injury. The generalized inflammatory reaction due to the extent of burns and an initial inadequate resuscitation are worsening factors. The inflammatory process may be responsible of lung injuries similar to those induced by smoke inhalation, even when there is no inhalation. The treatment remains symptomatic and based on the oxygen therapy, mechanical ventilation, prevention of infections and maintain of homeostasis by hydroelectrolytic adequate resuscitation. The nitric oxyde associated to the almitrin allows in a certain number of cases to minimize intra pulmonary shunting and to normalize the VA/O ratio. The development of treatments allowing to modulate inflammatory mediators may lead to news therapies in the future.     

2005年至2016年上海交通大学医学院附属瑞金医院老年严重烧伤特点分析

目的通过对老年严重烧伤患者特点回顾性研究,探讨老年严重烧伤流行病学特征,为未来烧伤学科在老年严重烧伤治疗领域提供较为详实的依据。 方法回顾性分析2005年1月1日至2016年12月31日入住上海交通大学医学院附属瑞金医院灼伤整形科的年龄≥60岁、烧伤总面积大于30%总体表面积(TBSA)的老年严重烧伤患者住院病史信息,收录信息包括患者入院日期、年龄、性别、烧伤面积和Ⅲ度烧伤面积、烧伤原因、受伤场所、合并伤前疾病、烧伤后并发症、合并吸入性损伤、生存患者重症加强护理病房(ICU)留治时间及治疗结果。对数据行重复测量方差分析、单因素方差分析、独立样本t检验、秩和检验、χ²检验、Fisher确切概率检验、二项分布检验,生存患者和病死患者对比有差异的因素(年龄、烧伤面积、Ⅲ度烧伤面积、吸入性损伤、存在伤后并发症)行单因素及多因素Cox回归分析。 结果本研究共收录老年严重烧伤患者73例,老年严重烧伤患者发病率从2005年2.7%上升到2017年17.8%,呈显著上升趋势,差异有统计学意义(χ²＝45.18,P<0.05)。男性患者(65.8%)多于女性患者(34.2%),差异有统计学意义(P＝0.01)。患者年龄分布为61～86岁,年龄中位数为66岁,男、女性患者年龄差异无统计学意义(Z＝－0.22,P＝0.83)。患者平均烧伤面积为(53.9±20.9)%TBSA,Ⅲ度烧伤面积中位数0。不同烧伤严重程度患者性别、年龄、烧伤原因比较,差异均无统计学意义(P值均大于0.05);特重度烧伤患者合并吸入性损伤例数、生存患者ICU留治时间、病死例数均多于重度烧伤患者,差异均有统计学意义(P值均小于0.05)。特重度烧伤患者中工作场所烧伤占比高。患者烧伤原因以火焰烧伤为主(79.5%),受伤场所以家庭为主(57.5%),其次为工作场所(31.5%)。患者伤前明确诊断疾病主要有心血管疾病32例(43.8%)、神经系统疾病7例(9.6%)、糖尿病5例(6.8%)、呼吸系统疾病5例(6.8%)。患者烧伤后并发症主要为创面感染31例(42.5%)、多器官功能障碍综合征8例(11.0%)、肺部感染8例(11.0%)。合并吸入性损伤11例(15.1%),生存患者ICU留治时间中位数为12 d。患者病死率为32.9%,烧伤总面积、Ⅲ度烧伤面积是影响老年严重烧伤患者病死的危险因素,Ⅲ度烧伤面积是影响老年严重烧伤患者病死的独立危险因素(HR为1.024, 95%CI为1.006～1.041,P＝0.008)。 结论随着社会老龄化,老年严重烧伤发病率显著增高,老年患者家庭烧伤占比高,应积极制定老年烧伤特别是家庭预防策略,切实降低发病率及减小烧伤面积、提高治愈率,建立有效烧伤康复体系改善患者愈后生存质量。