烧伤、整形：烧伤

大面积烧伤的综合治疗措施；人组织工程全层皮肤在烧伤创面中厚供皮区的应用；烧伤皮肤再生疗法救治严重烧伤的治疗要点——附110例病例总结和典型病例介绍；全颜面部深度烧伤的临床治疗；湿润烧伤膏治疗烧伤总面积〉50％TBSA患者的疗效观察……[编者按]     

湿润烧伤膏治疗烧伤患者的临床疗效及安全性

目的 探讨湿润烧伤膏用于治疗烧伤患者的疗效及安全性。方法 选择河北省沧州中西医结合医 院东院区2020年1月-2021年12月收治的40例烧伤患者，根据治疗方法的不同将其分为观察组和对照组，各 20例。对照组采用磺胺嘧啶银乳膏治疗，观察组采用湿润烧伤膏治疗，比较两组临床疗效、恢复时间、疼 痛程度以及瘢痕情况。结果 观察组治疗总有效率为95.00%，高于对照组的70.00%（P＜0.05）；观察组创 面愈合时间、肉芽生长时间均短于对照组（P＜0.05）；两组治疗后VAS疼痛评分均降低，且观察组低于对 照组（P＜0.05）；观察组瘢痕发生率及瘢痕严重程度低于对照组（P＜0.05）。结论 为烧伤患者提供湿润 烧伤膏进行治疗，可提升临床疗效，缓解疼痛程度，缩短患者创面愈合时间和肉芽生长时间，降低瘢痕发 生率，其疗效及安全性均得到保障。     

湿润烧伤膏和皮维碘软膏治疗重度烧伤的观察

为比较湿润烧伤膏和皮维碘软膏对重度烧伤的治疗效果。１９９１年７月至１９９５年６月对３５例烧伤面积在３０％以上的病人分别外用湿润烧伤膏和皮维碘软膏，结果表明；对浅Ⅱ度烧伤，两药的治疗结果无显著差异；对深度烧伤，湿润烧伤膏不如皮维碘软膏，前者抗菌能力差，愈合时间长，感染率，并发症发生率和死亡率均较高，也未见明显抑制瘢痕增生的作用，认为大面积深度烧伤病人应慎用湿润烧伤膏，尤其在气候炎热，潮湿的南方地区。     

新中药湿润烧伤膏治疗烧伤780例

目的：观察新中药湿润烧伤膏治疗烧伤的临床疗效。方法：应用自制的新中药湿润烧伤膏治疗烧伤患者780例。结果：780例中,有767例临床治愈,4例死亡,27例患者留有较严重的疤痕。结论;新中药湿润烧伤膏具有保护创面、消炎止痛、活血化瘀、除腐生肌、方便引流、促进创面愈合作用。同时还能抑制疤痕增生。     

湿润烧伤膏致小儿中小面积烧伤多系统并发症21例

文中报告了我科自１９９０年１月至１９９２年１２月收治的１２岁以下小儿烧伤，经院外湿润烧伤膏治疗后发生侵袭性全身感染，多脏器并发症及严重电解质紊乱而转入我科的２１例危重病例。年龄１～５岁，烧伤总面积５％～３０％（平均１６．０％±５．８％），均发生二个系统以上并发症和电解质紊乱。２１例中，死亡４例。我们认为使用湿润烧伤膏后造成的创面严重感染是导致多脏器损害的主要原因。因此，建议慎重使用湿润烧伤膏。     

湿润烧伤膏和皮维碘软膏治疗重度烧伤的观察

为比较湿润烧伤膏和皮维碘软膏对重度烧伤的治疗效果，１９９１年７月至１９９５年６月对３５例烧伤面积在３０％以上的病人分别外用湿润烧伤膏和皮维碘软膏，结果表明：对浅Ⅱ度烧伤，两药的治疗结果无显著差异；对深度烧伤，湿润烧伤膏不如皮维碘软膏，前者抗菌能力差，愈合时间长，感染率、并发症发生率和死亡率均较高，也未见明显抑制瘢痕增生的作用。认为大面积深度烧伤病人应慎用湿润烧伤膏，尤其在气候炎热、潮湿的南方地区。     

湿润烧伤膏在烧伤临床的应用

我们应用湿润烧伤膏于Ⅰ、Ⅱ度烧伤创面及供皮创面，并对用湿润烧伤膏包扎后的创面温度进行了测定，观察了烧伤肉芽组织埋存于湿润烧伤膏、复合抗生素软膏及碘醚膏中的菌量改变，结果说明：湿润烧伤膏无抑菌作用，也未发现其可促进或加速创面愈合的作用；包扎后的创面在湿润烧伤膏覆盖区与普通油纱布覆盖区，经测定温度基本一致，亦即湿润烧伤膏包扎后的局部条件与普通包扎疗法相比无特殊差别，临床过程也一致，如脱痂早、易感染等。因此，我们认为湿润烧伤膏对于烧伤Ⅰ度、浅Ⅱ度创面有一定的安抚作用，可酌情使用；在浅的真皮外露的创面使用时如配合抗生素治疗，也可适当选用湿润烧伤膏；但在深Ⅱ度创面使用应慎重。     

美宝湿润烧伤膏再生疗法与磺胺嘧啶银霜抗炎疗法治疗大面积烧伤的比较研究

目的：比较美宝湿润烧伤膏再生疗法与磺胺嘧啶银霜抗炎疗法治疗大面积烧伤的疗效.方法：选择62例大面积烧伤病人,随机分为两组,烧伤创面分别采用美宝湿润烧伤膏再生疗法（实验组）与磺胺嘧啶银霜抗炎疗法（对照组）治疗,观察两组病人休克期情况、不同深度烧伤创面的愈合时间、感染发生率、手术植皮例数及瘢痕发生率.结果：实验组病人休克期补液量明显比对照组少、尿量多于对照组（P＜0.05）;休克征象发生率比对照组少,但差异无显著性（P＞0.05）.实验组创面愈合时间、感染率、手术植皮比例及瘢痕出现率均明显低于对照组（P＜0.05）.结论：在大面积烧伤治疗中,美宝湿润烧伤膏再生疗法疗效优于磺胺嘧啶银霜抗炎疗法.     

湿润烧伤膏联合敏感抗生素外用治疗压疮

目的探讨压疮治疗的有效方法。方法将90例溃疡期压疮患者随机分为观察组、对照Ⅰ组、对照Ⅱ组各30例。观察组清创后采用湿润烧伤膏外涂加敏感抗生素外敷治疗。对照Ⅰ组采用湿润烧伤膏外涂加抗生素全身治疗。对照Ⅱ组采用庆大霉素湿敷。结果观察组治愈率显著优于对照Ⅱ组。愈合时间显著短于对照Ⅰ组、Ⅱ组（均P〈0．01）；治愈率与对照Ⅰ组比较。差异无显著性意义（P〉0．05）。结论湿润烧伤膏外涂加敏感抗生素外敷治疗溃疡期压疮疗效显著。可促进创面愈合。     

湿润烧伤膏、碘伏、磺胺嘧啶银糊及雷夫诺尔治疗115例深…

对１１５例深Ⅱ度烧伤分别使用湿润烧伤膏、０．２５％碘伏、磺胺嘧啶银糊及０．１％雷夫诺尔液进行治疗，结果表明：深Ⅱ度烧伤使用湿润烧伤膏在创面愈合、抑菌效果、治疗费用及瘢痕增生等方面存在明显不足。因此，建议深Ⅱ度烧伤应慎重使用湿润烧伤膏。     

Effect of varying burn sizes and ambient temperature on the hypermetabolic rate in thermally injured rats

BACKGROUND: Small animals with scald covering 50% of their total body surface area (TBSA) have been used to study the hypermetabolic burn response. In the 50% TBSA burn rat model, the area of normal skin that is available for animal instrumentation is restricted and the mortality rate has been high. The purpose of this study was to determine whether a smaller burn size can induce a similar hypermetabolic response with mortality rates lower than those of the 50% TBSA model. METHODS: Rats were randomly divided into four groups to receive a 0% (sham nonburned), 30%, 40%, or 50% TBSA third-degree scald burn. The hypermetabolic response was determined by measuring changes in body weight and oxygen consumption at ambient temperatures of 21, 26, and 31 degrees C for each burn size. Weight measurements were made daily while oxygen consumption was measured 7, 11, and 14 days after thermal injury. RESULTS: All thermally injured rats lost body weight; however, there were no significant differences between the 30, 40, and 50% TBSA burn groups. Burn induced a hypermetabolic response as indicated by an increase in oxygen consumption from 130 to 200% that of sham nonburned rats. No significant difference in oxygen consumption could be shown over the study period between the three burn sizes at different ambient temperatures. Mortality was 0% in the sham and 30% group, 10% for the 40% group, and 50% for the 50% TBSA burn group. CONCLUSIONS: From our study we conclude that a burn size covering 30% of the TBSA induces the same hypermetabolic response as a 50% TBSA burn.     

A three decade analysis of factors affecting burn mortality in the elderly

This study's objective was to identify variables that affect the mortality of elderly burn patients and to assess their changes over time. A retrospective review was conducted on all patients 75 or older (n = 201) admitted to a university-based burn center between 1972 and 2000. Variables examined were age, sex, TBSA, ABSI, inhalation injury, timing from burn to operative intervention, the number of surgical procedures, the number of pre-morbid conditions, and mortality. There were 95 fatalities. TBSA strongly correlated with mortality (p < 0.0001). Adjusting for TBSA and inhalation injury, mortality significantly decreased (p = 0.04, odds ratio = 0.58). Mortality significantly increased with inhalation injury (p < 0.01). Fatality risk increased by 400% with inhalation injury. Absence of inhalation injury was not significant with respect to mortality in the 1970s, however there was a significant decrease (p = 0.02) in mortality without an inhalation injury in the 1980s and 1990s. ABSI was strongly predictive of mortality (p < 0.0001). On average there was a 200% increase in mortality per unit increase of ABSI. The elderly are 58% less likely to die from burns now as compared to the 1970s. Although mortality rose with increasing TBSA equally in each decade, the absolute risk of mortality decreased over time. This data suggests major strides have been made in burn care, however similar success has not been achieved with inhalation injuries.     

Influence of demographics and inhalation injury on burn mortality in children

BACKGROUND: Pulmonary failure has emerged as one of the leading causes of mortality in burned children due, in part, to the success in reducing the incidence of sepsis, early surgery and fluid resuscitation, and new advances in nutritional support. To evaluate the effect of pulmonary injury, age, gender, race, and burn size on mortality, the records of 3179 burned children admitted to our burn center from 1985 to 2001 were reviewed. In this population, 1246 were admitted within 14 days of injury with burns greater than 20% of their total body surface area (TBSA). METHODS: Lethal burn areas (LAs) for a thermal injury only or burn plus inhalation injury were estimated from best fit probit curve within 95% confidence limits. Data analysis was by chi(2)-test, t-test, or Fisher's exact test where appropriate. RESULTS: The lethal burn area for a 10% mortality rate with and without concomitant inhalation injury was a 50 and 73% TBSA burn, respectively. Children up to the age of 3 with >/=20% TBSA burns had a higher rate of mortality (9.9%) compared to those 3-12 years of age (4.9%) and 13-18 years of age (4.2%). Children with 21-80% TBSA burns showed a significant difference in mortality (P<0.05) between those with burn plus inhalation injury (13.9%) and burn only (2.9%), while those with 81-100% TBSA burns showed no significant difference between burn only and burn plus inhalation injury. CONCLUSION: Inhalation injury remains one of the primary contributors to burn mortality. Children under the age of 3 years, however, are at a higher risk both with and without inhalation injury.     

Survival after burn in a sub-Saharan burn unit: Challenges and opportunities

Background

Burns are among the most devastating of all injuries and a major global public health crisis, particularly in sub-Saharan Africa. In developed countries, aggressive management of burns continues to lower overall mortality and increase lethal total body surface area (TBSA) at which 50% of patients die (LA50). However, lack of resources and inadequate infrastructure significantly impede such improvements in developing countries.

Methods

This study is a retrospective analysis of patients admitted to the burn center at Kamuzu Central Hospital in Lilongwe, Malawi between June 2011 and December 2012. We collected information including patient age, gender, date of admission, mechanism of injury, time to presentation to hospital, total body surface area (TBSA) burn, comorbidities, date and type of operative procedures, date of discharge, length of hospital stay, and survival. We then performed bivariate analysis and logistic regression to identify characteristics associated with increased mortality.

Results

A total of 454 patients were admitted during the study period with a median age of 4 years (range 0.5 months to 79 years). Of these patients, 53% were male. The overall mean TBSA was 18.5%, and average TBSA increased with age—17% for 0–18 year olds, 24% for 19–60 year olds, and 41% for patients over 60 years old. Scald and flame burns were the commonest mechanisms, 52% and 41% respectively, and flame burns were associated with higher mortality. Overall survival in this population was 82%; however survival reduced with increasing age categories (84% in patients 0–18 years old, 79% in patients 19–60 years old, and 36% in patients older than 60 years). TBSA remained the strongest predictor of mortality after adjusting for age and mechanism of burn. The LA50 for this population was 39% TBSA.

Discussion

Our data reiterate that burn in Malawi is largely a pediatric disease and that the high burn mortality and relatively low LA50 have modestly improved over the past two decades. The lack of financial resources, health care personnel, and necessary infrastructure will continue to pose a significant challenge in this developing nation. Efforts to increase burn education and prevention in addition to improvement of burn care delivery are imperative.     

Mortality following combined burn and traumatic brain injuries: An analysis of the national trauma data bank of the American College of Surgeons

BackgroundSevere burn and traumatic brain injuries (TBI) lead to significant mortality, and combined burn-TBI injuries may predispose towards even worse outcomes. The purpose of this study was to investigate the mortality of patients with burn, burn with non-TBI trauma, and combined burn/TBI to determine if combined injury portends a worse outcome.MethodsWe obtained the National Trauma Data Bank from 2007 to 2012, identifying 32,334 patients with burn related injuries, dividing this cohort into three injury types: BURN ONLY, BURN with TRAUMA/NO TBI, and BURN with TBI. For each patient, demographic data was obtained, including age, gender, presence of trauma, TBI, or inhalation injury, burn total body surface area (TBSA), Glasgow Coma Scale, Injury Severity Score, and mortality. Multivariable logistic regression was performed.ResultsAge, gender, and TBSA were similar across the three injury groups, but the incidence of inhalation injury was doubled in the BURN with TRAUMA/NO TBI (15.4 %) and BURN with TBI (15.3 %) groups when compared to the BURN ONLY (7.2 %) group. Mortality differed across injury categories after adjusting for age, TBSA, and inhalation injury. Increased mortality was seen in BURN with TRAUMA/NO TBI versus BURN ONLY (OR = 1.27 [1.06, 1.53]) and was higher when comparing BURN with TBI versus BURN ONLY (OR = 4.22 [2.85, 6.18]). BURN with TBI also had higher mortality when compared to BURN with TRAUMA/NO TBI (OR = 3.33 [2.30, 4.82]). The logs odds of mortality also increased with increasing age, TBSA and presence of inhalation injury.DiscussionThis analysis of the NTDB suggests that mortality following burn-related injuries may be higher when burn injury is combined with TBI when compared to burns with other trauma, even after correcting for age, TBSA, and inhalation injury. Further clinical and laboratory research is needed to validate these findings and better understand how to optimize combined TBI and burn injury treatment.     

Demographic characteristics and prognostic indicators of childhood burn in a developing country

Children constitute a significant proportion of burn victims in most studies from the developing countries. While there has been a progressive improvement in the outcome from childhood burn in many developed nations, the morbidity and mortality remains high in many low and middle income countries. The aim of our study is to evaluate the demographic characteristics and prognostic indicators of childhood burn in a major referral teaching hospital in a developing country. A review of the records of 638 patients with acute burns managed over a 10-year period from January 2001 to December 2010 at the University College Hospital, Ibadan Nigeria was done. The clinical and epidemiological data were retrieved from computerized data base using the ISBI proforma. Information obtained includes Biodata, Etiology, location, TBSA, presence of Inhalation injury and the treatment outcome. Data of patients aged 16 years and below were analyzed using the SPSS version 16. The main outcome measure was the patient's survival. 289 children representing 45.3% of the total number of burn patients were managed over the period. The M:F ratio was 1.1:1. The median age of the cohort was 4.0 years while the median TBSA was 21.0%. Non-intentional causes were responsible for 89.6% cases. Most of the injuries (88.6%) occurred at home. Eighty-three patients had inhalation injury out of which 57 (68.7%) deaths were recorded. The overall mortality rate in the cohort was 39.5% with an LA50 of burn size of 45%. The TBSA was also found to be a determinant of outcome.Majority of childhood burns are from preventable causes with attendant dismal mortality figures. Effective burn prevention strategies and improved quality of care remain pivotal in reducing childhood burn morbidity and mortality in the developing countries.     

烧伤合并中重度吸入性损伤的早期救治

目的：为提高中重度吸入性损伤治疗水平,探讨中重度吸入性损伤早期救治的方法。方法：对32例烧伤合并中重度吸入性损伤患者实施“四早”救治方案,即：早期气管切开;早期充分给氧;早期气道湿化、灌洗;早期纤维支气管镜检查及治疗。32例患者中,烧伤面积〈30％TBSA16例,30％～50％TBSA10例,〉50％TB—SA6例;Ⅲ度烧伤面积〈10％TBSA17例,10％～20％TBSA6例,〉20％TBSA9例。救治过程中观察患者气道黏膜损伤情况及愈合时间,监测气道灌洗前后、纤支镜治疗前后30min患者的心率、呼吸频率及动脉血气变化,纤支镜治疗前后痰标本作细菌培养。结果：32例中治愈28例,死亡4例,2例死于急性呼吸窘迫综合征,2例死于肺部严重感染,病死率12．5％;气道的愈合与黏膜损伤程度密切相关,与损伤部位关系不明显;气道灌洗前后和纤支镜治疗前后,患者的动脉血氧饱和度、动脉血氧分压升高,心率、呼吸频率减慢,动脉血pH值降低;纤支镜肺泡灌洗后气道内病原菌明显减少。中重度吸入性损伤患者应用“四早”救治方案后,显著地提高了救治的成功率。结论：对中重度吸入性损伤患者按“四早”方案进行救治是有效可行的。     

烧伤患者真菌感染分析

目的 了解烧伤患者真菌感染情况.方法 2003年1月-2006年12月,笔者单位共收治3909例烧伤患者.根据临床表现,对其中怀疑有真菌感染的467例患者,采集血液、痰液、气道灌洗液、动静脉导管、尿管、尿液、大便、创面分泌物等标本2271份,行真菌培养、鉴定及药物敏感试验.1例患者多个标本培养结果为同一真菌时计为1个阳性标本.并以创面分泌物、大便、尿液、痰液及气道灌洗液、动静脉导管或尿管、血液标本为升序,仅计最高级别标本为阳性;如同时查出2种以上不同真菌时,按不同标本计算.结果 在送检的2271份标本中,有61份标本真菌培养阳性,阳性率2.69%.3909例患者中有36例(38份阳性标本)发生真菌感染,总阳性病例发生率为0.92%.36例真菌培养阳性患者中烧伤面积大于80%TBSA 18例,50%～79%TBSA 12例,30%～49%TBSA 4例,小于30%TBSA 2例.其真菌培养阳性时间为:烧伤后1周内发生2例,第2周发生6例,第3周发生16例,3周后发生12例.在36例真菌感染患者中有8例死亡,病死率为22.22%.在38份阳性标本中,培养检出最多的为热带假丝酵母菌及白色念珠菌.所检出的真菌除光滑球样酵母菌耐药较严重外,其他真菌对多数抗真菌药物如两性霉素B、氟康唑、伊曲康唑等敏感.念珠球样酵母菌对所有药物敏感,热带假丝酵母菌对氟康唑、酮康唑、5-氟胞嘧啶等敏感性较好.结论 烧伤患者常有真菌感染,当临床怀疑有真菌感染时,应进一步检查确诊,并尽早开始抗真菌治疗.