成批热水泥烧伤的救治

目的 总结成批热水泥烧伤病人救治经验。方法 组织专科技术力量,处理成批烧伤病人入院的复杂过程,休克期尿量维持在50-80ml/h,中、重度吸入性损伤,采取早期气管切开,大面积、深度烧伤病人,早期大面积切、削痂植自体微粒皮术。结果 本组27批184例热水泥烧伤病人中180例平稳渡过休克,为97.8％。气管切开43例,40例治愈。早期大面积切削痂植微粒皮术86例,早期切痂植皮率46.7％。184例病人中179例病人治愈,治愈97.2％。结论 成批热水泥烧伤病人入院过程复杂,必须组织得力,抢救和治疗得当,病人平稳渡过休克,中、重度吸入性损伤早期气管切开,早期大面积切、削痂植皮,是成功抢救、治愈成批热水泥烧伤病人的关键,取得满意效果。     

热水泥粉尘大面积烧伤13例

在烧制水泥过程中，常发生水泥熟料喷窑致伤事故。我科１９９２～１９９６年共收治热水泥粉尘致烧伤患者２１例，其中烧伤面积大于３０％的烧伤患者１３例。我们总结了热水泥粉尘致大面积烧伤的临床特点及早期处理的体会，现报告如下。１临床资料本组１３例，均为男性，年...     

热水泥粉致吸人性损伤的救治体会

我院自 1997年～ 2 0 0 1年共收治吸入性损伤病人 49例 ,现就对其中的 11例热水泥粉所致吸入性损伤的治疗情况报告如下 :1　临床资料1.1　一般资料　 11例患者全部为热水泥粉烧伤 ,且均于伤后 0 .5～ 2h入院。其中男 10例 ,女 1例。年龄 2 1～ 47岁。烧伤总面积 5 0 %～ 97%。Ⅲ度面积 2 5 %～ 65 %。1.2　临床特点　 (1) 11例患者均为附近水泥厂一线操作工人 ;(2 )所有患者均有面、颈部皮肤烧伤 ;(3 )事故现场均未戴口罩及其它防护面具 ,入院时患者口、鼻腔均有水泥粉粘附 ,中、重度吸入性损伤者 ,多有口、舌、鼻、咽喉部粘膜剥脱 ;(4 )除 …     

16批烧伤病人的救治体会

为进一步做好成批烧伤的防治工作，对以往接收和参加救治的１６批烧伤病人进行总结分析。结果表明：本地区成批烧伤多发生于缺医少药的基层，存在早期补液不充分、多以晶体液为主、创面污染严重、容易忽略吸入性损伤、病人过于集中耽误功能部位的早期手术治疗等特点。吸入性损伤是第一位致死原因，其次是败血症和高钠血症。认为应建立自上而上的烧伤医疗网络以增加烧伤治疗的覆盖面，强调要重视吸入性损伤并改进其现场急救措施，转送     

一批26例烧伤病人的救治体会

目的 总结成批烧伤的救治经验。方法 对2002年3月14日收治的一批共26例烧伤病人进行回顾性总结，救治中及时启动成批烧伤预案、实施“四早”(即早期气管切开、早期充分液体复苏、早期切削痂植皮和早期胃肠道营养)方案。结果 25例治愈，1例于烧伤后10h死于MODS。结论 有必要建立“成批烧伤救治应急预案”；大面积烧伤休克期应强调“个体化液体复苏”；应用综合治疗方案；重视复合伤的早期救治。     

成批烧伤的救治体会

成批烧伤的救治中存在着许多矛盾 ,如专科技术力量与病人数量的矛盾 ;病人与医疗器材和药品的矛盾等。既要集中力量抢救危重病人又要照顾一般病人 ,故治疗难度较大〔1〕。这在技术人力较薄弱的基层医院尤为突出。 1988年 11月至 2 0 0 0年 2月我科共抢救 11批重大事故共计 6 8例 ,取得了较好的治疗效果。1　临床资料1 1　一般资料 :本组共 11批共 6 8例 ,其中男性 5 1例 ,女性 17例 ,年龄 6岁至 6 8岁 ,平均 32 5岁 ,最大烧伤面积为 95 %。Ⅲ度面积为 80 % ,最小烧伤面积为 4 % ,平均烧伤面积为 2 8 6 % ,Ⅲ度面积为15 7%。 11批中最多一…     

成批烧伤的救治体会

成批烧伤为突发意外事件,一般伤员多,伤情复杂。对成批烧伤是否及时、正确的救治,直接影响到患者的生命安全和肢体功能恢复。本院自2004年8月至2009年8月,收治三批共62例烧伤患者,由于组织指挥有力以及休克期成功复苏、早期气管切开、合理使用抗生素、及时有计划的切削痂植皮等,取得了满意的治疗效果。现报道如下。     

成批烧伤的救治体会

成批烧伤是突发性公共卫生事件的一部分,因事故突发性,不仅受伤人数众多,而且伤情较重,临床救治非常困难,但只要组织、措施和治疗方法得当,成批烧伤病人的救治,可以取得满意的效果.现将笔者近10年参加抢救12批烧伤患者的救治体会,报道如下.     

烧伤合并吸入性损伤的救治体会

有关烧伤合并吸入性损伤救治的文献报道较少。我矿2004年发生瓦斯爆炸事故，该批病人14例，均为烧伤合并吸入性损伤患者，经救治治愈13例，死亡1例，治愈率92．8％。本文即对大面积烧伤合并吸入损伤的救治经过进行总结，报告如下：     

成批烧伤救治体会

目的探讨成批烧伤的救治。方法回顾分析我院救治的4批次27例烧伤患者的临床资料。结果本组27例患者中,19例患者平稳度过休克期后治愈;8例出现休克,其中3例死亡;24例治愈患者平均于伤后40d创面基本愈合。治疗效果较满意。结论组织得力、实施规范医疗救治措施,成批烧伤取得了满意的治疗效果。     

耳廓烧伤829例临床治疗分析

目的总结耳廓烧伤的临床特点和治疗经验.方法对近15年829例耳廓烧伤病例进行分析.结果829例病员中5例死亡,其余均痊愈.666例出现有不同程度色素沉着.148例出现有包括瘢痕增生和耳廓形态异常等畸形,对116例进行了相应后期畸形的整复,效果满意.结论耳廓烧伤除非全层碳化外,局部创面一般不宜采用早期手术.预防耳软骨炎的发生并进行妥善处治,注意耳廓局部的护理,积极对继发的后期畸形予以治疗等是保证取得耳廓烧伤良好治疗效果的关键.     

成批特重度烧伤救治中临床多学科工作团队（MDT）机制的应用

目的：探讨临床多学科工作团队（ MDT）机制在救治成批特重度烧伤过程中发挥的重要作用。方法：成批特重度烧伤患者在整个救治过程中,包括急救处理、抗休克治疗、手术治疗、抗感染治疗及脏器并发症的治疗等环节均引入MDT机制,总结治疗经验,分析MDT在各环节发挥的作用。结果：本组5例患者在MDT机制干预下均治愈,且无1例出现截指（趾）情况,预后良好。结论：MDT机制在救治成批特重度烧伤患者中作用显著。     

成批爆炸烧伤的救治组织

目的探讨成批爆炸烧伤伤员救治组织的方法和措施。方法启动成都市紧急重大灾情救援系统，从本组3批81例爆炸烧伤的现场救治、救治组织领导、伤员及时合理分流、后续治疗等方面总结经验。结果3批81例伤员，治愈80例，治愈率99．99％。结论成都市急救中心和市应急办紧急重大灾情救援系统对成批爆炸烧伤伤员的救治组织效果满意。     

重度吸入性损伤的早期救治

目的探讨重度吸入性损伤早期救治的方法。方法对29例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。结果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。结论对重度吸入性损伤患者按"四早"方案进行救治是有效可行的。     

Treatment of hot tar burns

Hot tar burns, although rare, usually occur in workers in the paving and roofing industries. When tar is heated to high temperatures it can cause deep burns, and its removal often causes further damage. However, the use of one of the polysorbates (surface-active agents) makes removal easy and painless.     

Treatment strategies for mass burn casualties

Background Mass burn casualties are always a great challenge to a medical team because a large number of seriously injured patients were sent in within a short time. Usually a high mortality is impending. Experiences gained from successful treatment of the victims may be useful in guiding the care of mass casualties in an armed conflict. Methods Thirty-five burn victims in a single batch, being transferred nonstop by air and highway from a distant province were admitted 48 hours post-injury. All patients were male with a mean age of （22.4±8.7） years. The burn extent ranged from 4% to 75% （（13.6±12.9）%） total body surface area. Among them, thirty-two patients were complicated by moderate and severe inhalation injury, and tracheostomy had been performed in 15 patients. Decompression incisions of burn eschar on extremities were done in 17 cases before transportation. All the thirty-five patients arrived at the destination smoothly via 4-hour airlift and road transportation. Among them, twenty-five patients were in critical condition. Results These thirty-five patients were evacuated 6 hours from the scene of the injury, and they were transferred to a local hospital for primary emergency care. The patients were in very poor condition when admitted to our hospital because of the severe injury with delayed and inadequate treatment. Examination of these patients at admission showed that one patient was suffering from sepsis and multiple organ dysfunction syndrome. Dysfunction of the heart, lung, liver, kidney, and coagulation were all found in the patients. Forty-eight operations were performed in the 23 patients during one month together with comprehensive treatment, and the function of various organs was ameliorated after appropriate treatment. All the 35 patients survived. Conclusions A well-organized team consisting of several cooperative groups with specified duties is very important. As a whole, the treatment protocol should be individualized, basing on the extent of the injury and the care that the patient had received at the spot. During airlift, the stretchers should be arranged perpendicular to the longitudinal axis of the cabin. The treatment protocol in our hospital consisted mainly of prompt effective relief of all life-threatening complications, followed by early closure of burn wounds, appropriate use of anti-infection therapy, emphasis on nutritional support, correction of metabolic disorders, alleviation of immunosuppression, correction of coagulopathy, and effective support and protection of organ function.     

Successful treatment of invasive burn wound infection with sepsis in patients with major burns

Objective To investigate the clinical characteristics of invasive burn wound infection wit h sepsis in patients with major burns and to summarize the successful experience s in the treatment of such patients. Methods Eight patients with major burns, complicated by invasive burn wound infection an d sepsis were consecutively admitted to our hospital from September 1997 to Octo ber 1998.Among them, 6 patients developed multiple organ dysfunction syndrome (MODS) and 2 developed septic shock.The plasma concentrations of IL-6, IL-8, TNFα and lypopolysaccharide (LPS) were assayed before and after surgical inter vention, as well as when the patient’s vital signs became stable.Results The patients’ conditions usually deteriorated abruptly when extensive invasive b urn wound infection emerged.While multi-microbial infection was usually found , Pseudomonas aeruginosa was the predominant bacteria isolated from the sube schar tissue.The plasma concentrations of IL-6, IL-8, TNFα and LPS before s urgical intervention were significantly higher than those after surgical interve ntion (P<0.05).The lowest levels of the inflammatory mediators were obser ved when the patients’ conditions became stable, and the values were signifi cantly lower than those before surgical intervention (P<0.001). Conclusion Since the main cause of burn wound sepsis is the presence of a large area of i nfected burn wound, they should be excised and covered as early as possible.LP S and pro-inflammatory mediators play an important role in the pathogenesis of burn sepsis.Although favorable results should be attributed to comprehensive t reatment, we believe that early, aggressive and thorough surgical excision of in fected burn wounds, followed by sound and complete coverage of the area, play a crucial role.     

1036例小儿烧伤治疗分析

目的 通过1036例小儿烧伤治疗分析，探讨有效的治疗方法，以提高治愈率。方法 选择1990年8月-2000年12月收治的1036例小儿烧伤患，对其治疗效果进行分析。结果 1036例中治愈788例，好转225例，死亡21例。结论 休克期要尽早开通大静脉通道，多巡视，早期发现问题，解决问题；休克早期必须进食；创面处理注意保护技体功能，减少残障。     

结膜碱性烧伤致干眼模型的探讨

目的：建立并评价新型干眼动物模型方法。方法　新西兰白兔20只,随机分为实验组和对照组,1.0N的NaOH溶液结膜化学烧伤干眼造模,定期行干眼临床检查、结膜印迹细胞学和免疫组化检测。结果　实验眼结膜充血及分泌物、荧光素钠和虎红染色积分术后第1天表现最明显,后逐渐下降;泪膜破裂时间7d下降最明显,后逐渐延长,与对照组比较差异有显著性（p<0.05）;基础泪液分泌与对照组比较差异无显著性（p＞0.05）;杯状细胞密度与MUC5AC阳性率和积分在4周内均与对照组比较差异有显著性（p<0.05）。结论　结膜碱烧伤制作的干眼模型是一种操作简单、稳定的制模方法。     

MEEK微型皮片植皮技术在成批烧伤救治中的临床应用

目的：探讨MEEK微型皮片植皮技术在成批烧伤患者创面修复中的应用价值。方法对7批34例重度烧伤患者创面共计112例次手术采用MEEK微型皮片植皮技术修复创面,采用不同的扩展比例(1：4、l：6和1：9)绉纱材料,观察MEEK微型皮片移植成活率、愈后瘢痕增生挛缩情况等。结果103例次手术患者采用1：4或1：6比例MEEK微型皮片移植,皮片成活率在95%以上,创面愈合;9例次手术采用1：9比例MEEK微型皮片移植,皮片未能完全融合,后期行1~2次邮票皮片移植后创面愈合。术后随访,扩展比例为1：9的9例术区瘢痕挛缩明显,余患者有轻、中度挛缩。结论采用Meek植皮治疗效果肯定,是成批烧伤患者创面修复的有效方法。