目的 探讨吸入性损伤流行病学特点,总结喉烧伤诊断标准的临床应用经验. 方法 收集笔者单位1999年1月-2013年6月收治的443例吸入性损伤患者病历资料.统计患者性别、年龄、吸入性损伤严重程度、合并症及伤前疾病,不同程度吸入性损伤患者的烧伤总面积、Ⅲ度烧伤面积、伤后入院时间及喉烧伤情况,患者治疗及预后情况包括气管切开率、切开时间及并发症、病死率及死亡原因等.对数据行非参数Kruskal-Wallis检验、x2检验,对吸入性损伤严重程度与烧伤总面积、喉烧伤严重程度、气管切开率、病死率的相关性行Spearman相关分析. 结果 (1)本组患者中男353例占79.7％,女90例占20.3％,男女比例约4∶1.小于或等于20岁者64例占 14.4％,大于20岁且小于或等于40岁者203例占45.8％,大于40岁且小于或等于60岁者144例占 32.5％,大于60岁者32例占7.2％.本组患者中轻、中、重度吸入性损伤患者分别为297、108、38例.7例有合并症,21例有伤前疾病.不同程度吸入性损伤患者的烧伤总面积和Ⅲ度烧伤面积均差异明显(H值分别为73.752、142.830,P值均小于0.01),伤后入院时间差异无统计学意义(H=1.528,P＞0.05).相关分析显示吸入性损伤严重程度与烧伤总面积呈明显正相关(r=0.399,P＜0.001).轻度吸入性损伤患者中,轻度喉烧伤占68.0％(202/297),中度喉烧伤占32.0％(95/297),重度喉烧伤0例;中度吸入性损伤患者中,轻度喉烧伤0例,中度喉烧伤占53.7％ (58/108),重度喉烧伤占46.3％ (50/108)喉烧伤情况总体比较差异有统计学意义(x2=336.703,P＜0.001).相关分析显示喉烧伤严重程度与吸入性损伤严重程度呈明显正相关(r =0.700,P＜0.001).(2)本组患者总体气管切开率为37.02％(164/443).轻、中、重度吸入性损伤患者的气管切开率分别为10.44％ (31/297) 、87.96％(95/108)、100.00％ (38/38),差异明显(x2=271.654,P＜0.001).相关分析显示气管切开率与吸入性损伤严重程度呈明显正相关(r=0.784,P＜0.001).本组患者气管切开时间以伤后6 h以内为主占63.4％ (104/164).气管切开并发症发生率为5.5％(9/164).(3)本组患者中共31例死亡,病死率为7.00％.轻度吸入性损伤患者病死率为1.01％ (3/297),中度吸入性损伤患者病死率为12.96％(14/108),重度吸入性损伤患者病死率为36.84％(14/38),差异明显(H=74.273,P＜0.001).相关分析显示病死率与吸入性损伤严重程度呈明显正相关(r=0.371,P＜0.001).死亡患者的死亡原因中,脓毒症14例占45.2％,呼吸功能衰竭7例占22.6％,呼吸道梗阻2例占6.5％,呼吸道出血2例占6.5％,脑出血2例占6.5％,心脏意外2例占6.5％,中枢性尿崩1例占3.2％,另有1例占3.2％因经济原因放弃治疗自动出院. 结论 吸入性损伤患者中,男性占绝大多数,青中年构成比最高.吸入性损伤严重程度与烧伤总面积、喉烧伤严重程度、气管切开率、病死率相关.利用喉烧伤诊断标准和气管切开指征,可有效避免喉梗阻风险;早期行预防性气管切开手术,有利于降低手术难度和风险.
目的 探討吸入性損傷流行病學特點,總結喉燒傷診斷標準的臨床應用經驗. 方法 收集筆者單位1999年1月-2013年6月收治的443例吸入性損傷患者病歷資料.統計患者性彆、年齡、吸入性損傷嚴重程度、閤併癥及傷前疾病,不同程度吸入性損傷患者的燒傷總麵積、Ⅲ度燒傷麵積、傷後入院時間及喉燒傷情況,患者治療及預後情況包括氣管切開率、切開時間及併髮癥、病死率及死亡原因等.對數據行非參數Kruskal-Wallis檢驗、x2檢驗,對吸入性損傷嚴重程度與燒傷總麵積、喉燒傷嚴重程度、氣管切開率、病死率的相關性行Spearman相關分析. 結果 (1)本組患者中男353例佔79.7％,女90例佔20.3％,男女比例約4∶1.小于或等于20歲者64例佔 14.4％,大于20歲且小于或等于40歲者203例佔45.8％,大于40歲且小于或等于60歲者144例佔 32.5％,大于60歲者32例佔7.2％.本組患者中輕、中、重度吸入性損傷患者分彆為297、108、38例.7例有閤併癥,21例有傷前疾病.不同程度吸入性損傷患者的燒傷總麵積和Ⅲ度燒傷麵積均差異明顯(H值分彆為73.752、142.830,P值均小于0.01),傷後入院時間差異無統計學意義(H=1.528,P＞0.05).相關分析顯示吸入性損傷嚴重程度與燒傷總麵積呈明顯正相關(r=0.399,P＜0.001).輕度吸入性損傷患者中,輕度喉燒傷佔68.0％(202/297),中度喉燒傷佔32.0％(95/297),重度喉燒傷0例;中度吸入性損傷患者中,輕度喉燒傷0例,中度喉燒傷佔53.7％ (58/108),重度喉燒傷佔46.3％ (50/108)喉燒傷情況總體比較差異有統計學意義(x2=336.703,P＜0.001).相關分析顯示喉燒傷嚴重程度與吸入性損傷嚴重程度呈明顯正相關(r =0.700,P＜0.001).(2)本組患者總體氣管切開率為37.02％(164/443).輕、中、重度吸入性損傷患者的氣管切開率分彆為10.44％ (31/297) 、87.96％(95/108)、100.00％ (38/38),差異明顯(x2=271.654,P＜0.001).相關分析顯示氣管切開率與吸入性損傷嚴重程度呈明顯正相關(r=0.784,P＜0.001).本組患者氣管切開時間以傷後6 h以內為主佔63.4％ (104/164).氣管切開併髮癥髮生率為5.5％(9/164).(3)本組患者中共31例死亡,病死率為7.00％.輕度吸入性損傷患者病死率為1.01％ (3/297),中度吸入性損傷患者病死率為12.96％(14/108),重度吸入性損傷患者病死率為36.84％(14/38),差異明顯(H=74.273,P＜0.001).相關分析顯示病死率與吸入性損傷嚴重程度呈明顯正相關(r=0.371,P＜0.001).死亡患者的死亡原因中,膿毒癥14例佔45.2％,呼吸功能衰竭7例佔22.6％,呼吸道梗阻2例佔6.5％,呼吸道齣血2例佔6.5％,腦齣血2例佔6.5％,心髒意外2例佔6.5％,中樞性尿崩1例佔3.2％,另有1例佔3.2％因經濟原因放棄治療自動齣院. 結論 吸入性損傷患者中,男性佔絕大多數,青中年構成比最高.吸入性損傷嚴重程度與燒傷總麵積、喉燒傷嚴重程度、氣管切開率、病死率相關.利用喉燒傷診斷標準和氣管切開指徵,可有效避免喉梗阻風險;早期行預防性氣管切開手術,有利于降低手術難度和風險.
목적 탐토흡입성손상류행병학특점,총결후소상진단표준적림상응용경험. 방법 수집필자단위1999년1월-2013년6월수치적443례흡입성손상환자병력자료.통계환자성별、년령、흡입성손상엄중정도、합병증급상전질병,불동정도흡입성손상환자적소상총면적、Ⅲ도소상면적、상후입원시간급후소상정황,환자치료급예후정황포괄기관절개솔、절개시간급병발증、병사솔급사망원인등.대수거행비삼수Kruskal-Wallis검험、x2검험,대흡입성손상엄중정도여소상총면적、후소상엄중정도、기관절개솔、병사솔적상관성행Spearman상관분석. 결과 (1)본조환자중남353례점79.7％,녀90례점20.3％,남녀비례약4∶1.소우혹등우20세자64례점 14.4％,대우20세차소우혹등우40세자203례점45.8％,대우40세차소우혹등우60세자144례점 32.5％,대우60세자32례점7.2％.본조환자중경、중、중도흡입성손상환자분별위297、108、38례.7례유합병증,21례유상전질병.불동정도흡입성손상환자적소상총면적화Ⅲ도소상면적균차이명현(H치분별위73.752、142.830,P치균소우0.01),상후입원시간차이무통계학의의(H=1.528,P＞0.05).상관분석현시흡입성손상엄중정도여소상총면적정명현정상관(r=0.399,P＜0.001).경도흡입성손상환자중,경도후소상점68.0％(202/297),중도후소상점32.0％(95/297),중도후소상0례;중도흡입성손상환자중,경도후소상0례,중도후소상점53.7％ (58/108),중도후소상점46.3％ (50/108)후소상정황총체비교차이유통계학의의(x2=336.703,P＜0.001).상관분석현시후소상엄중정도여흡입성손상엄중정도정명현정상관(r =0.700,P＜0.001).(2)본조환자총체기관절개솔위37.02％(164/443).경、중、중도흡입성손상환자적기관절개솔분별위10.44％ (31/297) 、87.96％(95/108)、100.00％ (38/38),차이명현(x2=271.654,P＜0.001).상관분석현시기관절개솔여흡입성손상엄중정도정명현정상관(r=0.784,P＜0.001).본조환자기관절개시간이상후6 h이내위주점63.4％ (104/164).기관절개병발증발생솔위5.5％(9/164).(3)본조환자중공31례사망,병사솔위7.00％.경도흡입성손상환자병사솔위1.01％ (3/297),중도흡입성손상환자병사솔위12.96％(14/108),중도흡입성손상환자병사솔위36.84％(14/38),차이명현(H=74.273,P＜0.001).상관분석현시병사솔여흡입성손상엄중정도정명현정상관(r=0.371,P＜0.001).사망환자적사망원인중,농독증14례점45.2％,호흡공능쇠갈7례점22.6％,호흡도경조2례점6.5％,호흡도출혈2례점6.5％,뇌출혈2례점6.5％,심장의외2례점6.5％,중추성뇨붕1례점3.2％,령유1례점3.2％인경제원인방기치료자동출원. 결론 흡입성손상환자중,남성점절대다수,청중년구성비최고.흡입성손상엄중정도여소상총면적、후소상엄중정도、기관절개솔、병사솔상관.이용후소상진단표준화기관절개지정,가유효피면후경조풍험;조기행예방성기관절개수술,유리우강저수술난도화풍험.
Objective To explore the epidemiological characteristics of inhalation injury and to summarize the clinical application experience of diagnostic standard of burn of larvnx.Methods Medical records of 443 patients with inhalation injury admitted to our burn unit from January 1999 to June 2013 were analyzed,including gender,age,severity of inhalation injury,complications and diseases before injury; total area and that of full-thickness burn injury,admission time after burn,and burn condition of larynx of patients with different degrees of inhalation injury; treatment and outcome including rate,time,and complication of tracheotomy,mortality,and cause of death.Data were processed with nonparametric Kruskal-Wallis test and chi-square test.The relationship between severity of inhalation injury and total burn area,degree of burn of larynx,tracheotomy rate,and mortality was assessed by Spearman correlation analysis.Results (1) Among the patients,there were 353 (79.7％) male and 90 (20.3％) female,with the ratio of male to female 4∶ 1.There were 64 (14.4％) patients younger than or equal to 20 years,203 (45.8％) patients older than 20 years and younger than or equal to 40 years,144 (32.5％) patients older than 40 years and younger than or equal to 60 years,and 32 (7.2％) patients older than 60 years.The numbers of patients with mild,moderate,and severe inhalation injury were respectively 297,108,and 38.Seven patients suffered from complications,and 21 patients had diseases before injury.There were statistically significant differences among the patients with different degree of inhalation injury in regard to total burn area and fullthickness burn area (with H values respectively 73.752 and 142.830,P values below 0.01),while no statistically significant difference was observed in admission time after burn (H =1.528,P ＞0.05).Correlation analysis showed that severity of inhalation injury was positively correlated with total burn area (r =0.399,P ＜0.001).Among the patients with mild inhalation injury,incidences of patients with mild,moderate,and severe burn of larynx were respectively 68.0％ (202/297),32.0％ (95/297),and 0,and those among the patients with moderate inhalation injury were respectively 0,53.7％ (58/108),and 46.3％ (50/108).There were statistically significant differences in degree of burn of larynx of patients with different degree of inhalation injury (x2 =336.703,P ＜ 0.001).Correlation analysis showed that severity of burn of larynx was positively correlated with severity of inhalation injury (r =0.700,P ＜0.001).(2) The rate of tracheotomy was 37.02％ (164/443).The rates of tracheotomy in patients with mild,moderate,and severe inhalation injury were respectively 10.44％ (31/297),87.96％ (95/108),and 100.00％ (38/38),x 2 =271.654,P ＜ 0.001.Correlation analysis showed that the rate of tracheotomy was positively correlated with severity of inhalation injury (r =0.784,P ＜ 0.001).Tracheotomy was done mainly within 6 h post burn (63.4％,104/164).The incidence rate of complication of tracheotomy was 5.5％ (9/164).(3) Thirty-one patients died,with a mortality rate of 7.00％.The mortality rates of patients with mild,moderate,and severe inhalation injury were respectively 1.01％ (3/297),12.96％ (14/108),and 36.84％ (14/38),H =74.273,P ＜0.001.It was found that the mortality was positively correlated with severity of inhalation injury (r =0.371,P ＜0.001).The causes of death of the patients were respectively sepsis (14,45.2％),respiratory failure (7,22.6％),airway obstruction (2,6.5％),airway hemorrhage (2,6.5％),cerebral hemorrhage (2,6.5％),cardiac accident (2,6.5％),and diabetes insipidus (1,3.2％),and 1 (3.2％) patient quit treatment and discharged from hospital for economic reason.Conclusions Among the patients with inhalation injury,male is dominated in number,and the young adults formed the highest constituent ratio.The severity of inhalation injury was correlated with total burn area,severity of burn of larynx,tracheotomy rate,and mortality.With the guidance of diagnostic criteria of burn of larynx and indication of tracheotomy,the risk of laryngeal obstruction can be eliminated.The early preventive tracheotomy can decrease the difficulty and risk of the operation.
