Epidemiology and bacterial colonization of burn injuries in Blantyre

Forty-nine patients from the Burns Unit at the QECH had swabs taken from various sites in order to determine the bacterial profile and antibiotic susceptibilities in burn wounds colonized by bacteria. The mean age was 16 years (range 1–70 years); 27 (55 %) of the study population were female and 22 (45%) were male. Twenty-four (49%) patients were epileptic. Open fire (41%) was the most common cause of burn injuries among epileptics while hot water burns (29%) were commonest among non-epileptics. Burn injury and percentage total burn surface area (% TBSA) injuries decreased with age, and the upper and lower limbs, trunk, head and neck were the most commonly affected sites. Staphylococcus aureus was the commonest isolate (23%), followed by Proteus mirabilis (22.7%), Streptococci spp (15.9%), Pseudomonas aeruginosa (4.5%) and 3.4% for Escherichia coli, Salmonella and Klebsiella spp. There was a significant trend of bacterial growth with increasing % TBSA (p<0.001). Bacterial growth was significantly more common in more recent burns of less than 20 days compared to burns of longer duration (OR 4.1 [95% CI 1.58–10.99]). Broad-spectrum antibiotics are required as first-line therapy for burns-related sepsis but there is need for surveillance of antibiotic susceptibility to help determine appropriate therapy.     

烧伤合并急性肾功能衰竭的临床研究

目的：探讨烧伤合并急性肾功能衰竭（ARF）的早期指标检测以及各种危险因素和疗效。方法：选择2008年1月～2009年6月所收治的中重度热烧伤患者75例,Ⅱ度或Ⅲ度烧伤面积累计达20％～70％TBSA。所有患者在入院时、入院后3d、7d、14d和21d检测血清肌酐（Scr）、血尿素氮（BUN）、肌酐清除率（Ccr）、24h尿量、尿蛋白、尿微量白蛋白（mALB）。结果：75例烧伤患者中有14例（18．7％）并发ARF。烧伤合并ARF组平均Scr、Ccr和尿蛋白水平在住院7d后明显高于烧伤未合并ARF组（P均〈0．05）,平均BUN水平在住院14d后明显高于烧伤未合并ARF组（P〈0．05）,平均尿量在住院21d后明显高于烧伤未合并ARF组（P〈0．05）。烧伤合并ARF组在入院时mALB水平已达正常值3-4倍,在观察期均高于烧伤未合并ARF组（P均〈0．05）。烧伤面积与脓毒症是烧伤并发ARF的主要危险因素（负相关系数r分别为0．52和0．23,P均〈0．05）。14例ARF患者中有10例患者行血液净化治疗,其他4例患者给予相应治疗。12例患者痊愈,2例患者（14.3％）分别死于严重脓毒症和多器官功能衰竭。结论：本组资料显示．mALB是早期监测ARF的敏感指标,烧伤合并ARF与烧伤面积与脓毒症相关,连续性静脉－静脉血液滤过（CVVH）治疗烧伤合并ARF疗效较好．     

血浆游离线粒体DNA拷贝数与烧伤患者病情的相关性

目的 探讨不同程度烧伤患者血浆游离线粒体DNA(mtDNA)拷贝数变化及在烧伤病情中的作用。 方法 根据患者烧伤程度、面积(TBSA)选取重度烧伤患者30例(重度烧伤组)及中度烧伤患者30例(中度烧伤组),纳入同期30名健康体检者(正常对照组)。采集所有参试者入院第1、8~11、18~21天的血浆标本。所有血浆标本经试剂盒提取DNA,通过实时荧光定量PCR法检测血浆游离mtDNA拷贝数。分析mtDNA拷贝数与急性生理学和慢性健康状况Ⅱ(APACHEⅡ)、多器官功能障碍综合征评分(MODS)、TBSA、Ⅲ°烧伤面积、烧伤指数及生化指标间相关性,并将上述指标进行Logistic回归分析。 结果 重度烧伤组入院第1天血浆游离mtDNA拷贝数高于中度烧伤组和正常对照组,重度烧伤组血浆游离mtDNA拷贝数在第8~11天到达峰值之后降低; mtDNA拷贝数与烧伤总面积、Ⅲ°烧伤面积、烧伤指数、APACHE Ⅱ评分、MODS呈正相关(P<0.05),与生化指标天冬氨酸氨基转移酶、谷丙氨酸氨基转移酶、总胆红素、降钙素原、白细胞呈正相关(P<0.01),与总蛋白、白蛋白及前白蛋白呈负相关(P<0.01);经Logistic回归分析显示,患者APACHEⅡ评分和住院当天mtDNA拷贝数为烧伤严重程度的独立危险因素(P<0.05);mtDNA拷贝数在诊断烧伤程度的ROC曲线下面积为0.904,敏感度为0.833,特异性为0.867。 结论 烧伤患者血浆游离mtDNA拷贝数与烧伤程度和多项生化指标具有相关性,为临床判断烧伤程度提供依据。     

小儿烧伤的流行病学分析

对近5a收治的886例15岁以下小儿烧伤患者的年龄，性别，烧伤原因，面积，部位，地点，发病季节，转归等流行病学资料进行统计分析。结果：小儿烧伤5岁以下儿童占86．8％，男性占62％，女性占38％，冬春季发病率52％，夏秋季48％，热液和火焰为主要致伤原因（94．5％），家庭内损伤占91％，四肢和躯干为好发部位，烧伤面积在30％以下占91．3％，死亡率0．5％，烧伤面积在30％以上死亡率14．5％，火焰烧伤死亡率高于热液烫伤（P＜0．05），多脏器衰竭，全身感染和休克是主要死亡原因，结论：小儿烧伤，重在预防。     

锌对烫伤大鼠表皮生长因子及其受体表达的影响

目的：观察锌对烫伤后低锌大鼠表皮生长因子及其受体表达的影响．方法：SD大鼠64只,制作20％体表总面积（TBSA）深Ⅱ度烫伤大鼠模型,随机分为单纯烫伤组和锌治疗组．检测伤后第1,3,5,7d血清锌含量,观察组织学改变,并采用免疫组化技术检测创面表皮生长因子及其受体的表达变化．另取8只正常大鼠作为对照组,分别检测上述指标．结果：单纯烫伤组伤后第1日血清锌（0．097±0．006）mg／L与对照组（0．133±0．005）mg／L相比较明显下降（P〈0．01）,第7日恢复正常．锌治疗组伤后第1日血清锌与正常对照组无明显差异（P〉0．05）,伤后第3,5,7日明显上升,分别为（0．148±0．007）,（0．164±0．006）,（0．172±0．007）mg／L,高于正常对照组及单纯烫伤组（P〈0．01）．正常皮肤和伤后第1日的创面组织内表皮生长因子及其受体无表达或仅呈弱阳性表达,伤后第5,7日,单纯烫伤组和锌治疗组表皮生长因子的表达均增加,但锌治疗组高于单纯烫伤组（P〈0．05）;伤后第3,5,7日,单纯烫伤组和锌治疗组表皮生长因子受体的表达增加,锌治疗组高于单纯烫伤组（P〈0．05）．结论：锌对烫伤后低锌大鼠表皮生长因子及其受体表达有促进作用,从而起到加速创面愈合的作用．     

成批中重度烧伤患者长途转送后的救治

目的:分析成批危重烧伤患者长途转运后并发症及总结其救治经验。方法:两批烧伤中的重度烧伤患者13名,分别于伤后3 d和4 d由外地长途空运转入,烧伤面积75％±25％,Ⅲ度烧伤面积63％±34％且有中度吸人性损伤;入院时所有患者已出现创面溶痂,大部分患者分别或同时有休克、严重高钠血症、白细胞总数低、低蛋白血症、应激性溃疡出血等并发症。治疗措施包括:①入院后尽快行相关检查,掌握病情;尽快处理休克和严重高钠血症等危及生命并发症。②尽快手术封闭创面。③加强抗感染治疗的同时,积极实施器官功能及免疫支持。结果:入院后并发症得到迅速纠正,大部分患者顺利恢复。5例Ⅲ度烧伤面积≥95％患者伤后2周左右始出现脓毒症和器官功能不全。经积极对症处理和器官支持等治疗3例治愈,2例分别因自体皮极度匮乏和急性乙型肝炎而死亡。结论:成批烧伤中的危重患者长途转运后极易出现危及生命的并发症;掌握并发症发生特点并及早处理是成功救治的关键。     

不同烧伤面积患者早期钙离子浓度的影响因素与临床意义

目的 分析不同烧伤面积患者早期钙离子浓度的影响因素与临床意义。方法 选取2019年1月—2022年6月南通大学附属医院烧伤整形外科收治的符合入选标准的住院患者116例作为研究对象，对其病例资料进行回顾性分析。结果 两组患者的性别、年龄、吸入性损伤及入院时间比较，差异均无统计学意义（P>0.05）。发生低钙血症患者三度创面的比例高于未发生低钙血症患者，发生低钙血症患者入院时白蛋白浓度低于未发生低钙血症患者，烧伤面积大于未发生低钙血症患者（P <0.05）。患者三度创面、大面积烧伤（烧伤面积> 50%）、低蛋白血症等因素间钙离子浓度比较，差异均有统计学意义（P <0.05）；患者性别、年龄、吸入性损伤、延迟复苏（入院时间> 6 h）等因素间钙离子浓度比较，差异均无统计学意义（P>0.05）。多因素逐步线性回归分析结果显示，大面积烧伤、低蛋白血症及年龄是影响患者入院时钙离子浓度的独立危险因素（P <0.05），且大面积烧伤与低蛋白血症是影响钙离子浓度的主要因素。患者三度创面、大面积烧伤、低蛋白血症、低钙血症等因素间创面愈合时间比较，差异均有统计学意义...     

小猪皮移植在三度烧伤治疗中的临床应用

应用新鲜猪皮代替同种异体皮治疗三度烧伤创面64例。条状猪皮和自体皮间隔移植复盖,最大面积50％,其愈合时间13天:肉芽创面单纯猪皮复盖,最大面积25％,粘附时间20～30天。并介绍了猪皮移植后组织学变化,说明猪皮可有效复盏深度烧伤创面,是良好的生物敷料。     

A Clinical Analysis of 1255 Children with Burn Injuries

In a twenty-five year period(1958-1983),there were altogether 4651burn cases admitted to this institute,of whom 1255 were children(26.95%).Themortality rate of this series of young victims was 4.7%(59 cases).The causes ofdeath were septicemia(30 cases),shock(17),cerebral edema and cerebral hernia(4),acute renal failure(4),severe burn wound sepsis(2),and pulmonarycomplications resulting from severe inhalation burns(2).Since the mortality and the incidence of shock and septicemia were closelyrelated to the extensiveness of the burn injuries,a new classification of burninjuries in children is suggested as follows:1.Mild burns:The affected area is less than 10% TBSA.2.Moderate burns:10-29% TBSA is injured.3.Severe burns:30-49% TBSA is injured.4.Extremely severe burns:More than 50% TBSA is injured.     

30例儿童中度烧伤救治分析

目的分析儿童中度烧伤的治疗措施及效果。方法回顾性分析我院2007年1月～2009年12月收治的30例中度烧伤的儿童的临床资料,总结治疗的经验。结果本组30例患儿,其中2例给予削痂后自体皮植皮,术后创面愈合良好,未出现移植皮坏死,术后20～25d痊愈出院。其余28例患儿,均采用保守治疗方法,创面在15～30d均全部愈合。本组患儿中有3例出现腹胀、腹泻症状,予饮食调节及对症处理后好转。结论中度烧伤患儿在住院早期要给以有效的补液、抗感染、营养支持等全身治疗措施,对于面积较大的Ⅲ度烧伤,要早期切削痂,给予自体皮的移植封闭创面;面积较小的中度烧伤,给予合理处理后不仅可以减少并发症的发生,而且也能有效促进创面快速修复,缩短住院时间。     

苯丙酸诺龙对烫伤大鼠成纤维细胞和肝细胞雄激素受体表达的影响

目的　探讨蛋白同化激素对成纤维细胞和肝细胞的作用机制。方法　采用2 0 %体表面积深 度烫伤大鼠模型32只,随机分为苯丙酸诺龙(NP)治疗组和对照(C)组,免疫组化法比较两组间肉芽组织成纤维细胞和肝细胞雄激素受体(AR)的表达及分布。结果　NP组成纤维细胞在烫伤后第4、7、14、2 1d AR的表达均明显高于对照组(P<0 .0 5 ) ;肝细胞在烫伤后第7、14、2 1d AR的表达明显高于对照组(P<0 .0 1)。结论　蛋白同化激素NP能够促进成纤维细胞和肝细胞AR的表达和活化。     

Factors associated with mortality and morbidity among pediatrics with burn injuries in Riyadh,Saudi Arabia

Objectives:To describe characteristics, mechanism, and factors associated with morbidity and mortality of pediatrics with burn injuries.Methods:This cross-sectional retrospective study examined all pediatrics with burn injuries carried out at King Abdulaziz Medical City, Riyadh, Saudi Arabia, from 2015-2020. Collected data included demographics, mechanism of burn, total body surface area (TBSA) burned, body region burned, incidence of infection, renal failure, scars, and respiratory events.Results:The study included 370 patients. Approximately 47.0% were aged ≤2 years, and 61.0% were males. The most common burn mechanism was scald burn (54%), 59.2% had a TBSA of 0-10%, and 60.3% had regional burns on the upper limbs. During follow-up, 5 patients died (incidence rate [IR]=1.60/100 patient/years [PYs]). Morbidity events included blood/sepsis infection (IR=2.87/100 PYs), urine infection (IR=8.30/100 PYs), wound infection (IR=21.72/100 PYs), renal failure (IR=0.96/100 PYs), and respiratory infections (IR=1.60/100 PYs). In a multivariate Cox regression analysis, factors independently associated with combined hazard of morbidity and mortality were female gender (hazard ratio [HR]=1.64, 95% confidence intervel [CI]: [1.01-2.67], p=0.047), TBSA (HR=3.20, 95% CI: [1.828-5.585], p<0.0001), and length of hospital stay (HR=3.14, 95% CI: [1.91-5.17], p=0.000).Conclusion:This study identifies certain characteristics suggestive of poor outcomes of pediatric burn injuries that are relevant to clinical management and prevention programs. Larger multicenter studies are required to fully characterize pediatric patients with burn injuries and to identify factors that adversely affect their prognosis.     

20例小儿深度烧伤手术治疗的疗效观察

目的：探讨小儿深度烧伤的临床特点及手术治疗方案。方法对2008年至2011年收治的共20例0～6岁,烧伤面积3％～45％体表总面积的小儿深度烧伤患者,采取早期液体复苏、有效的创面处理、合理选择手术方案、全身营养支持等综合治疗措施。结果20例患儿经一次手术创面完全愈合,术后4例电击伤共9只手指皮片挛缩明显,手指屈伸受限,2例髁部受皮区有瘢痕增生,皮片挛缩,余12例肢体创面皮片愈合良好。结论小儿深度烧伤患者,在积极有效的创面处理及全身营养支持基础上,手术方式以修复创面为主,可获较满意的后期功能与外形。     

Epidemiology of infant burn in Eastern Saudi Arabia

Objectives:

To identify the epidemiology, pattern, outcome, and impact of infant burns in Eastern Saudi Arabia.

Methods:

We conducted a retrospective review of admitted infants charts over 4 years (2008-2013) at the Burn Unit of King Fahad Hospital, Hofuf, Al-Ahsa, Saudi Arabia. The charts were reviewed for age, gender, etiology, site of injury, total body surface area (TBSA), depth of burn, hospital stay, and discharge status.

Results:

The total number of admissions to the Burn Unit was 510 cases. Out of these cases, 84 were infants, constituting 16.5% of total admissions. Scald burn was the most common etiology affecting 73 infants (86.9%). The highest percentage of total body surface area was between 5-10%, which occurred in 41 infants (48.8%). The average hospital stay was 10 days. No infant mortality was reported during this period.

Conclusion:

The prevalence of burns among infants in our hospital is high, and preventive measures must be implemented to decrease the occurrence of burns in this age group.Al-Ahsa is the largest governorate in Saudi Arabia’s Eastern Province, with a population of 1,079,156 people in 2010.1 Saudi Arabia is a young populated country, as 30.7% is below the age of 14.2 The number of pediatric burns is reportedly high in Saudi Arabia, mostly due to household hazards or due to habits that can be a possible burn source such as drinking tea and coffee from hot pots.3,4 Limited data is available on infant burns, worldwide.5 There is a scarcity of published data on infant burns from Saudi Arabia. The aim of this study is to identify the epidemiology, pattern, outcome, and impact of infant burns in eastern Saudi Arabia. Determine the burden of infant burns on the hospital by determining the number of infant admissions, and length of stay in the hospital. Finally start a preventive measures and public awareness to decrease the incidence of these burns.     

大面积深度烧伤早期磨痂防治感染的研究

目的研究早期大面积深Ⅱ度烧伤磨痂与烧伤感染的关系。方法对35例烧伤面积〉30%且创面以深Ⅱ度烧伤为主的烧伤患者,进行前瞻性研究。按对创面处理的方式不同,将其分为早期磨痂组和保痂组。保痂组17例,用苯扎溴铵简单清创,创面用磺胺嘧啶银乳膏包扎处理,并上悬浮床或翻身床,换药治疗。早期磨痂组18例,休克纠正后,48 h内在全麻下行磨痂术,用钢丝球磨除创面的坏死组织,刚好有小出血点为止,创面冲洗后,再用术尔泰纱布湿敷,最后将生物敷料（脱细胞猪皮）覆盖创面,外层用纳米银纱布加压包扎。比较两组患者全身炎症反应综合征及脓毒症发生率,以及内毒素（LPS）、TNF-α、IL-6、IL-8的动态变化。结果早期磨痂组,磨痂时间在伤后48 h以内,磨痂面积30%～60%,平均愈合时间为14.1 d,保痂组平均愈合间为19.8 d;磨痂组全身炎症反应综合征及脓毒发生率为31%,低于保痂组的85%。LPS、IL-6、IL-8同时低于保痂组。结论大面积深Ⅱ度烧伤早期全麻下磨痂,不仅能缩短创面愈合时间,而且降低创面感染及全身感染。     

丹参对烫伤大鼠早期血清CK-MB的变化的影响

目的 观察丹参对烫伤大鼠早期血清肌酸磷酸激酶同工酶(CK—MB)的变化的影响。方法wistar大鼠72只，随机分为假烫组(8只)、烫伤组(32只)、烫伤治疗组(32只)，复制大鼠30％体表面积Ⅲ度烫伤模型，动态观察各组烫伤后6、12、24、48h血清CKMB水平、心肌含水量以及心肌细胞线粒体超微结构的变化。结果 大鼠烫伤后心肌明显受损，表现为血清CK—MB水平上升，心肌组织含水量升高，线粒体肿胀、嵴紊乱，应用丹参注射液后可在一定程度上降低血清CK—MB水平以及心肌组织含水量，改善线粒体超微结构。结论 丹参对烫伤大鼠早期心肌损害有一定的保护作用。     

Cardowan coal mine explosion: experience of a mass burns incident

A coal mine explosion 1700 feet (516 m) underground and two miles (3.2 km) from the pit head resulted in 40 casualties. Two hours elapsed between the explosion and the arrival of patients at hospital. Six patients suffered mechanical injuries, only one of which was life threatening. Thirty six suffered burns; in 18 over 15% of the total body surface area was affected. Nineteen patients had a mild respiratory upset requiring oxygen treatment. The average length of inpatient stay in those admitted was 24 days. Early assessment and treatment in the accident and emergency department was relatively simple because of the large proportion of burn injuries. Lack of communication between site and hospital made administration of the disaster difficult.     

Effect of nutritional support of extensively burned patients with splenico-stomachictonic

From 1983-1988, 20 cases of extensive burns were administered Splenico-Stomachictonic to regulate gastrointestinal function. The burns were above 80% total body surface area and/or third degree burn area above 50%. 18 cases of the same conditions in the same period served as the control. After 10 days, the therapeutic group had a total effective rate of 95%, and the control group had a total effective rate of 67% (P less than 0.05). The marked efficiency of the therapeutic group was 75% and the control group was 38% (P less than 0.05). The survival rate of the therapeutic group was 65% and the control group was 33%. These results suggested that the traditional Chinese Splenico-Stomachictonic medicine could bring to the extensive burn patients good gastrointestinal function, which helps improve nutritional status.