磺胺嘧啶银与纳米银抗菌凝胶治疗30例烧伤患者疗效分析

1资料与方法 1.1临床资料及治疗方法 2008年4-9月笔者单位收治30例烧伤患者,其中男26例、女4例,年龄18～58岁[(29±14)岁],烧伤面积2%～10%TBSA[(5.7±1.3)%TBSA],其中浅Ⅱ度12例、深Ⅱ度10例、Ⅲ度8例.热水烫伤19例、火焰烧伤9例、电弧烧伤2例,患者均在伤后72 h内入院.排除创面明显感染、磺胺类药物过敏、糖尿病和其他疾病患者.     

治疗黄磷烧伤60例

临床资料 :1994年 1月～ 2 0 0 1年 12月笔者单位共收治黄磷烧伤患者 6 0例 ,其中男 5 9例、女 1例 ,年龄 17～ 4 5岁。伤后入院时间 2～ 96h。烧伤总面积 1%～ 97% [(18.86± 2 1.4 5 ) % ]TBSA,Ⅱ～Ⅲ度 ;其中烧伤面积≥ 10 %TBSA者 31例、≤ 9%TBSA者 2 9例。伤后立即用大量清水冲洗者 5 7例 ,冲洗时间 10～ 6 0min;未冲洗者 3例。用 0 .2 %～ 2 .0 %硫酸铜溶液冲洗或湿敷创面 6例 ,其中 1例烧伤总面积4 2 %、Ⅲ度 4 %TBSA的患者创面用 1%硫酸铜后发生急性溶血反应。合并休克 6例 ,恶心、呕吐 18例 ,支气管痉挛 1例 ,10例患者出现…     

成批烧伤的临床分析及早期处理

成批烧伤指由同一致伤原因同时引起10例以上或严重烧伤超过5例者[1] 。多由突发事故引起,伤员聚集,常伴有其他损伤,加上人力、物力及技术力量的短缺,易贻误抢救时机,增加后期治疗的难度。笔者回顾性分析了本单位1991～2 0 0 1年收治的2 7批4 2 1例烧伤患者的临床资料,旨在总结治疗经验,探讨成批烧伤的早期救治方法。临床资料:本组患者男2 78例、女14 3例。年龄9～5 2岁[(30 .4±7.4 )岁],烧伤总面积8%～98% [(5 4 .6±17.8) % ],其中Ⅲ度5 %～90 % [(2 4 .0±8.1) % ]TBSA。烧伤原因:瓦斯爆炸12批2 0 4例,火药燃爆9批16 8例,水泥窑坍塌2批…     

脱细胞猪皮与自体微粒皮联合移植治疗大面积烧伤27例

1 临床资料 本组患者27例,其中男19例、女8例,年龄1岁2个月～57岁[(34±15)岁],烧伤总面积25%～94%TBSA[(69±21)%TBSA],其中Ⅲ度创面10%～94%TBSA[(53±22)%TBSA].     

高压氧治疗12例深度烧伤植皮创面的效果观察

深度烧伤创面治疗时间一般较长,需经多次植皮,给患者带来极大痛苦和经济负担。笔者单位采用植皮后配合高压氧治疗,一次植皮成功取得显著效果,现报告如下。将12例患者设为氧疗组,男5例、女7例,年龄5~58岁[(32±5)岁],其中火焰烧伤5例、火药燃爆伤3例、热液烫伤4例,面积19%~52%[(32±4)%],Ⅲ度为(19±7)%TBSA.另随机抽取同期住院的12例患者作对照组,男6例女6例,年龄5~56岁[(32±5)岁],其中火焰烧伤5例、火药燃爆伤4例、热液烫伤3例,面积18%~51%[(31±4)%],Ⅲ度(19±6)%TBSA.两组患者一般情况比较,差异无统计学意义(P>0.05).氧疗组采用切痂…     

酚烧伤28例治疗体会

临床资料 :本组 2 8例 ,其中男 2 4例 ,女 4例 ,年龄 17～4 5岁 ,皆因工作时发生酚泄漏事故致伤 ,其中苯酚烧伤 12例、正甲酚烧伤 3例、间甲酚烧伤 5例、对甲酚烧伤 4例、对苯二酚烧伤 4例 ,酚的体积分数为 2 0 %～ 70 %。烧伤面积为0 .5 %～ 2 4 .0 %TBSA ,其中 0 .5 %～ 6 .0 %TBSA者 10例 ,6 .0 %～12 .0 %TBSA者 12例 ,>12 .0 %TBSA者 6例 ,平均烧伤面积为 9.5 %TBSA。创面位于颜面部、颈部、四肢等暴露部位 ,以深Ⅱ度为主 ,呈白色、棕红色和棕褐色 ,干燥无渗出 ,痛、触觉迟钝。其中 4例患者伤后出现烦躁 ,随即转为淡漠、少语的…     

重度烧伤患者休克期血浆B型钠尿肽含量变化及意义

目的 了解重度烧伤患者休克期血浆B型钠尿肽(BNP)含量变化,探讨其临床意义.方法 选择笔者单位收治的伤后4 h内入院、年龄18～60岁、烧伤总面积大于或等于30%或者Ⅲ度面积大于或等于10%TBSA的患者42例,分为:烧伤A组,总面积30%～50%或者Ⅲ度10%～20%TBSA;烧伤B组:总面积大于50%或Ⅲ度大干20%TBSA.每组各21例.以同期住院的20例整形患者为对照组.检测各组患者入院时血浆BNP、肌酸激酶(CK)、心肌型肌酸激酶同工酶(CK-MB)及肌钙蛋白I(TnI)水平.测定并计算42例烧伤患者伤后8、16、24、48 h TnI、BNP及液体入量的整体水平.对其中的BNP值与液体人量作相关性分析.结果 入院时,烧伤A组患者BNP值为(68±19)ng/L,烧伤B组为(99±38)ng/L,均明显高于对照组[(17±7)ng/L,P<0.01];烧伤A、B组TnI值[(2.13±0.67)、(2.98±0.58)μg/L]亦明显高于对照组[(0.12±0.03)μg/L,P<0.01];3组患者CK、CK-MB值接近(P>0.05).42例烧伤患者伤后48 h内BNP持续增高,与液体人量呈正相关;TnI于伤后24 h达高峰,伤后48 h下降.结论 血浆BNP是反映重度烧伤后早期心肌缺血缺氧变化的敏感指标,且与早期液体复苏量呈正相关,可用于指导休克期液体复苏.     

救治大面积热水泥烧伤合并吸入性损伤42例

临床资料:笔者单位1986年3月～2 0 0 2年3月收治热水泥烧伤合并吸入性损伤患者4 2例,其中男4 0例、女2例;年龄17～4 8岁[(2 4 .6±6 .8)岁]。烧伤面积5 0 %～10 0 %[(75 .2±10 .3) % ],Ⅲ度2 0 %～90 % [(43.5±12 .7) % ]TB SA,其中5 0 %～80 %TBSA 2 9例、80 %～10 0 %TBSA 13例。吸入性损伤患者轻度14例、中度12例、重度16例;伤后16h内气管切开2 9例,16h后气管切开3例。治疗:入院后迅速清理患者鼻、口腔中积存的水泥热料,快速高流量吸氧,气管切开后改为持续低流量吸氧。吸痰、气道湿化,雾化吸入1次/ 4h,每次15min,雾化液配制:等渗…     

妊娠期烧伤后用药致新生儿病理性黄疸的原因分析

临床资料:笔者单位1981年1月-2003年12月共收治44例妊娠期烧伤患者,年龄23～31[(26.0±1.1)]岁,烧伤面积为10%～62%,平均32.5%TBSA,浅Ⅱ～Ⅲ度.孕龄为5～9[(7.8±0.7)]个月.致伤原因:火焰烧伤15例、热水烫伤26例、热油烫伤3例,均无吸入性损伤,伤前无重大疾患.患者出院后随访,2例终止妊娠,10例发生新生儿病理性黄疸.     

血浆降钙素原的测定在烧伤脓毒症早期诊断中的意义

2001—2003年笔者单位收治严重烧伤患者 32例,其中男 25例、女 7例。年龄 1 ~ 61岁,烧伤总面积为 ( 52±25)%,Ⅲ度(29±21)%TBSA.其中 11例出现脓毒症,男 10例,女 1例,年龄 1~50岁,烧伤面积(54±27)%,Ⅲ度 (31±23)%TBSA.伤后 1—3d,每日抽取患者静脉血检测血浆降钙素原 (P     

Experience of immediate burn wound excision and grafting for patients with extensive burns

The treatment of the patients with extensive burns has advanced dramatically in the past 10 years, and the mortality rate has also been reduced. The establishment of the skin-bank network as well as the development of emergency and critical care medicine can be cited as reasons Moreover, immediate burn wound excision and grafting for patients with extensive burns may be beneficial. Meticulous management is required perioperatively to perform these procedures safely during burn shock. Patients with extensive burns are susceptible to hypothermia while receiving massive fluid resuscitation. We use a warmer device (Level 1) to keep burn patients warm. From 1991 to 2003, we performed immediate burn wound excision and grafting in 26 extensively burned patients within 24 hours after burn injury. We completed the surgery within 2 hours and excised burn wounds covering 40% of the total body surface area (TBSA). The mean age was 57 +/- 22 (mean +/- SD years), the mean burn surface area (% of TBSA) was 47 +/- 20, the mean burn index was 45 +/- 19, and the mean prognostic burn index was 94 +/- 36. There were 15 survivors and 11 deaths, for an overall mortality rate of 43%.     

Cultured epithelial autografts in extensive burn coverage of severely traumatized patients: a five year single-center experience with 30 patients

OBJECTIVE: We report recent five-year experience in a large, single center series of severely burned and otherwise traumatized patients given cultured epithelial autografts (CEA) from a single commercial laboratory. SUMMARY BACKGROUND DATA: Initial optimism over CEA application has been tempered by subsequent reports asserting that this modality is unreliable and expensive. Discussion continues over its clinical role. METHODS: From 1991 to 1996, CEA were applied to a mean 37+/-17% of total body surface area (TBSA) of 30 patients. These patients had 78+/-10% average burn size, 65+/-16% average third-degree burn size, 90% prevalence of endoscopically confirmed inhalation injury and 37% prevalence of other serious conditions. RESULTS: CEA achieved permanent coverage of a mean 26+/-15% of TBSA, an area greater than that covered by conventional autografts (a mean 25+/-10% of TBSA). Survival was 90% in these severely burned and otherwise traumatized patients. Final CEA take was a mean 69+/-23%. In subset analyses, only younger age was significantly associated with better CEA take (p = 0.0001 in univariate analysis, p<0.04 in multivariate analysis, Student's t-test). CONCLUSIONS: Epicel CEA successfully provided extensive, permanent burn coverage in severely traumatized patients, proving an important adjunct to achievement of a high survival rate in a patient population whose prognosis previously had been poor. In our experience CEA appear to have a very high beneficial value in the management of bur ns >60% TBSA. In some cases studied it is very likely that CEA was a life-saving treatment.     

Acute physiology, age, and chronic health evaluation (APACHE) III score is an alternative efficient predictor of mortality in burn patients

The present study was performed to evaluate the prognostic value of the acute physiology, age, chronic health evaluation (APACHE) III score in burn patients. We hypothesised that APACHE III score efficiently predicts mortality of burn patients as it reflects the physiological changes in the acute phase and the severity of the underlying illness. Data such as age, gender, inhalation injury, total burn surface area (TBSA), burn index (BI), prognostic burn index (PBI), APACHE III score and outcome of 105 hospitalised patients were analysed retrospectively. TBSA, BI, PBI, and APACHE III score in the mortality group were significantly higher than those of surviving group. The mean scores of surviving versus mortality groups were as follows: TBSA, 19.2+/-17.8% versus 69.1+/-28.4%, p<0.0001; BI, 12.8+/-13.1% versus 66.8+/-28.6%, p<0.0001; PBI, 68.8+/-26.0% versus 124.4+/-33.6%, p<0.0001; APACHE III score, 28.4+/-22.2% versus 71.3+/-32.1%, p<0.0001. PBI and APACHE III score showed marked associations between higher scores and higher mortality. APACHE III score showed a significant correlation with PBI (p<0.0001). The present study suggested that APACHE III score could be used as an alternative efficient predictor of mortality in burn patients.     

Analysis of pediatric burns in Nagasaki University from 1983 to 2002

Pediatric burns are frequently observed: twenty-year burn analysis was performed in a single department, and 354 cases, aged 0-6 years old. The major cause of pediatric burns was scalding (68%) and hot water comprised over half of the scald burns. At 1 year old and younger, the total burn surface area (TBSA) was significantly smaller than from 1 to 6 years old (4.8+/-9.56 versus 10.5+/-18.86%, respectively, p<0.001). TBSA of scald burns was significantly greater than contact burns (8.9+/-15.76 versus 0.9+/-2.0%, respectively, p<0.05). Surgery was performed for 65 patients (18%) and 126 patients were hospitalized (34%). Compared to the first decade of analysis, the second decade had fewer patients (222 versus 142 cases) and lower severity (7.4+/-14.6% versus 6.6+/-13.26%, TBSA). Pediatric burns in younger children should be studied closely as to their causes and with further follow-up.     

Stenotrophomonas maltophilia bacteremia in burn patients

Stenotrophomonas maltophilia has been increasingly reported as a nosocomial opportunistic pathogen in debilitated patients, including burn patients. There is, however, only one published report in English that discusses S. maltophilia bacteremia in burns. We performed a retrospective chart review and statistical analysis of the incidence, the duration of hospital stays before a diagnosis of bacteremia, antimicrobial susceptibility, prognosis, and mortality risk factors in burn patients. From January 1996 to December 2004, 14 episodes of S. maltophilia bacteremia in 13 of 666 patients admitted to the burn center at our hospital were identified. The patients, nine males and four females, ranged in age from 1 to 76 years (mean: 42.9+/-24.4 years). Eleven injuries were from flame burns and two were from scald burns. The mean total burned surface area (TBSA) was 47+/-30.2% and mean prognostic burn index (PBI) was 81.7+/-31.3. The average annual incidence was 2.3 episodes per 1000 admissions, and no outbreak cluster was noticed. The mean hospital stay before bacteremia was 19.8+/-11.9 days. Most isolates were susceptible to ticarcillin-clavulanate (87.5%) and moxalactam (85.7%). The overall mortality was 30.7% (4/13) and correlated significantly with TBSA (P<0.01) and PBI (P<0.05). The incidence of S. maltophilia bacteremia was higher in hospitalized burn patients than in hospitalized non-burn patients. Different antimicrobial susceptibility patterns may exist, especially in different geographic regions. Awareness of the possibility of infection by this opportunistic pathogen and commencement of adequate antibiotics treatment, especially after 3 weeks of intensive care, should be incorporated into the strategy of treatment in major burn patients.     

The role of inhalation injury in burn trauma. A Canadian experience.

From 1977 to 1987, 1705 thermally injured patients were admitted to the Firefighters' Burn Center at the University of Alberta Hospitals. Thirteen hundred forty-four were male (78.8%) and 361 were female (21.2%), with a mean total burn surface area (TBSA) of 15.1 (SEM +/- 0.4%) and a range of 1% to 99% TBSA. Sixteen hundred thirty-five patients survived to be discharged from hospital, with an overall survival rate of 95.9%. One hundred twenty-four burn patients (7.3%) suffered concomitant inhalation injury diagnosed by bronchoscopy. Patients with inhalation injury suffered from larger TBSA (39.7% +/- 2.8% versus 12.2% +/- 0.3%; p less than 0.01) than those without inhalation injury. Inhalation injury increased the number of deaths from burn injury (34.7% versus 1.7%; p less than 0.01) independent of age and TBSA. Inhalation injury was associated with a threefold prolongation of hospital stay (23.7 +/- 0.7 versus 74.4 +/- 6.2 days; p less than 0.01) and was independent of age and TBSA. Multifactorial probit analysis was performed for both inhalation- and noninhalation-injured burned patients to allow TBSA and age adjusted rates of mortality for the burn population presented. The maximum detrimental effects of inhalation injury in burn patient outcome occurred when it coexisted with moderate (15% to 29% TBSA) to large (30% to 69% TBSA) thermal injuries. These data demonstrate that inhalation injury is an important comorbid factor in burn injury that increases the number of deaths substantially. Most importantly such injuries also independently prolong the duration of hospitalization in a highly unpredictable fashion as compared to patients with cutaneous burns only. As such our data illustrate the extreme importance of inhalation injury as a comorbid factor following thermal injury and reveal the present limitations for accurate quantification of the magnitude of respiratory tract injury accompanying thermal trauma.     

A review of the trends of self-inflicted burns

During 1979-1998, 7139 patients were admitted to the Birmingham Burns Centre. Of these, 184 patients were identified with self-inflicted burns. There were 115 males and 69 females. The mean age was 37.4 +/- 14.6 years and mean size of burn was 41.1 +/- 31.3% of total body surface area (TBSA). The yearly admissions of these burns appeared to show a decline, while their percentage as compared to burn admission from other causes showed a rise in the trend. Statistically, however, these trends were not different from zero. During the studied period, there were 446 deaths, of which 81 (18%) were due to self-inflicted burns. The mortality in the self-inflicted burn patients was therefore 44%. The average size of burn in those who died was 67% TBSA, while in those who survived was 21% TBSA. The observed mortality when compared with expected mortality, as derived from mortality probability chart, showed that the self-inflicted group had the same risk of dying as burns from other causes. The methods of burning were not available in 16 patients. In the remaining, self-immolation with an accelerant was the most preferred method followed by ignition of clothing without an accelerant (98 and 37 patients, respectively). In conclusion, self-inflicted burns remain a regular cause of admission to burn units. The extent of their burn is often large, because a majority use an accelerant, and thus, accounts for the high mortality in this group.     

52例严重烧伤休克期血流动力学变化监测

OBJECTIVE: To determine the benefit of hemodynamic monitoring for resuscitation of burn shock. METHODS: A group of 52 burned patients with mean burn area of (69.9 +/- 20.1)% TBSA burn injury (range 31%-100%), and mean III burn area of (60.4 +/- 13.6)% TBSA were included in this study. Swan-Ganz catheters were inserted to monitor hemodynamics including RAP, PAP, PAWP, HR, CO, CI, and SI, etc. after admission at 8, 16, 24, 36, 48, 72, and 96 hours postburn. RESULTS: It was reasonably safe to perform invasive monitoring during early resuscitation. With the guide of hemodynamic monitoring, evidence of global hypovolemia disappeared at 24 hours after burn injury with appropriate resuscitation therapy. CONCLUSION: Invasive hemodynamic monitoring may be necessary to optimize resuscitation of serious burn patients with reasonable safety.     

A study of burn injuries in the elderly in a regional burn centre

We evaluated the epidemiology and outcome of 94 elderly burn patients of age 60 years or older treated in a local burn centre over a period of 6 years. There were 44 males and 50 females with a male to female ratio of 0.88 and an average age of 73.8+/-9 years. The mean extent of burn was 13.3+/-18.4% total body surface area (TBSA) with 14 patients (15%) suffering from a burn size >20% TBSA. The vast majority of injuries (90%) occurred at home. Scalds resulted in 62 admissions (66%) and flame burns accounted for another 29 admissions (31%). The burns predominantly involved the extremities and the trunk. Four patients had inhalation injuries and required admission to the Intensive Care Unit for ventilatory support. The majority of patients (60%) did not require any operations. The mean hospital stay of the survivors was 30.1+/-34.1 days and 35% of them stayed less than 2 weeks. Fifty-five patients (59%) had at least one pre-existing medical problem requiring long-term medication and 41 patients (44%) were living alone. Sixty-three patients (67%) presented more than 8 h after the burn injuries and 34 patients (36.2%) had no first aid treatment of their burn wounds. In addition, 40 patients (42.5%) had their wounds treated inappropriately. Seven patients died in this series which yielded a mortality rate of 7.4%. The outcomes of early versus late excision and grafting were also analyzed.     

The use of a bioactive skin substitute decreases length of stay for pediatric burn patients

BACKGROUND: To optimize burn care for children, the authors introduced a protocol incorporating the use of a bioactive skin substitute, TransCyte (Advanced Tissue Sciences, La Jolla, CA). This study was designed to determine whether this management plan was safe, efficacious, and decreased hospital inpatient length of stay (LOS) compared with conventional burn management in children. METHODS: All pediatric burns greater than 7% total body surface area (TBSA) that occurred after October 1999 underwent wound closure with TransCyte (n = 20). These cases were compared with the previous 20 consecutive burn cases greater than 7% TBSA that received standard therapy. Standard therapy consisted of application of antimicrobial ointments and hydrodebridement. The following information was obtained: burn mechanism, age, size of burn, requirement of autograft, and LOS. Data were analyzed using the student's t test. RESULTS: Data for age, percent TBSA burn and LOS are reported as means +/- SEM. The children who received standard therapy were 2.99 +/- 0.7 years compared with those receiving TransCyte were 3.1 +/- 0.8 years. There was no difference between the treatment groups with regard to percent TBSA burn: standard therapy, 14.3 +/- 1.4% TBSA versus TransCyte, 12.7 +/- 1.3% TBSA. There was no difference in the type of burns in each group, the majority were liquid scald type, 70% in the standard therapy group versus 90% in the TransCyte group. Only 1 child in the TransCyte group required autografting (5%) compared with 7 children in the standard therapy group (35%). Children treated with TransCyte had a statistically 6 significant decreaed LOS compared with those receiving standard therapy, 5.9 +/- 0.9 days versus 13.8 +/- 2.2 days, respectively (P =.002). CONCLUSIONS: This is the first study using TransCyte in children. The authors found that this protocol of burn care was safe, effective, and significantly reduced the LOS. This new approach to pediatric burn care is effective and improves the quality of care for children with burns.