汽车内火药爆炸烧伤的特点及其救治

目的:探讨公交车内火药爆炸致伤特点、救治方法及施治中的组织工作。方法:以2001年元月-2004年12月所救治的3大批46例汽车内火药爆炸烧伤为样本,分析受伤人员其成分构成、烧伤部位、烧伤深度、复合伤、并发症等特点及其急救治疗、创面处理和施治中的组织方法。结果:伤员以中小学生为主(69.57%):烧伤面积较大且较深(平均面积/Ⅲ度面积48.31±12.42%TBSA/25.30 6.83%TBSA):伤员几乎均含颜面部和双手烧伤;合并伤及复合伤多(65.22%):治愈45例(治愈率98%);创面愈合时间:浅Ⅱ度6-12天,深Ⅱ度16-26天,Ⅲ度24-36天,未发生明显功能障碍和过度瘢痕形成;其中5例较深部位经异体皮复合自体表皮干细胞移植,经免疫组化法对角蛋白19型细胞的检测和临床愈合过程观察,其结果令人满意。结论:①MEBT/MEBO作为成批伤员救治中创面处理的首选方法具有无可替代的作用:②以异体皮复合自体表皮干细胞移植于较深创面能加速创面的原位再生,进一步提高愈合质量:③公交车内火药爆炸烧伤其伤员多为社会特殊群体组成,且人员集中,伤势严重,社会影响大,医务人员工作量大。因此,做到严密组织和科学分工才能保障对突发事件中的大批伤员实施快捷高效的救治。

The characteristics and treatment of burn wounds caused by gunpowder explosion on bus

Objective： To explore the characteristics of burn caused by gunpowder explosion on bus, its treating method and organization work in the treatment, Method： 46 patients in 3 groups burned by gunpowder explosion on bus were treated in our hospital during the period from Jan 2002 to Dec 2004. The clinical data including the profession of the patients, burn position, burn depth, compound injury and complications as well as emergency treatment, wound management and organization work were analyzed. Result： Most of the patients were primary and middle school students （69.57%）, the burn area was rather large and the wounds were deep （average area/3^rd degree wound area=48.31%±12.42% TBSA/25.30%±6.83% BSA）. Almost all the patients had burn wounds in face and hands. 65.22% of them had complications and compound injury. After treatment, 45 cases were cured （curative rate 98%）. Wound healing time： superficial 2^nd degree wounds healed in 6 to 12 days, deep 2^nd degree wounds in 16 to 26 days and 3^rd degree wounds in 24 to 36 days. No dysfunction happened and no hyperplastic scar formed. 5 cases had deep wound were subjected to allo-skin-grafting associated with auto-skin stem cell grafting. Keratin 19 type cells were found by immuno-histological detection method and the wound healing process was satisfactory. Conclusion： 1. MEBT/MEBO is of the first choice for treating burn patients in group. 2. Allo-skin-grafting in association with auto-skin stem cell grafting is suitable for treating deep wounds. It can promote in situ regeneration of the skin and enhance the wound healing quality. 3. Burn accidents on bus may result in a mass of casualties. The social influence is significant. The victims always have severe burn and the treating work is arduous, so that good organization and scientific division of the treating work is very important, in order to achieve efficient and effective rescue of the victims.