昆山“8·2”爆炸事故存活伤员损伤特点及救治分析  

Features of survived casualties and treatment strategies in Kunshan ＆quot;August 2＆quot; explosion aaccident

作　　者：刘军[1] 赵富丽[1] 吴健[1] 吴曙华[2] 杨爱祥[1] 李晓英[1] 彭霄[1] 常新[3] 程宏宇[4] 吴允孚[1] 

机构地区：[1]南京医科大学附属苏州医院重症医学科,江苏省苏州215001 [2] 苏州大学附属第二医院 [3] 南京医科大学附属淮安一院医学影像科 [4] 南京医科大学附属淮安一院烧伤科

出　　处：《中华急诊医学杂志》2015年第9期952-957,共6页Chinese Journal of Emergency Medicine

基　　金：江苏省自然科学基金（BK20141175）;江苏省卫生厅科技项目（Z201414）;中国博士后科学基金资助项目（2013M542578）;江苏省博士后科研资助项目（1301005A）;苏州市科技局科技计划项目（SYS201251）;南京医科大学哲学社会科学发展专项（2013NJZS50）;南京医科大学哲学社会科学发展专项（2013NJZS53）

摘　　要：目的 回顾性分析昆山“8·2”爆炸事故伤员损伤特点,探讨爆炸事故伤员的救治策略.方法 以“8·2”爆炸事故送至南京医科大学附属苏州医院ICU集中救治的40例伤者为对象,详细记录伤者性别、年龄、损伤类型、烧伤面积、深度等信息,分析伤后90 d内器官损伤的类型、感染部位及病原体、器官功能支持及医疗救治效果等.结果 爆炸事故后收住本院的伤者40例,男性28例,女性12例;创伤类型包括烧伤、吸入性损伤、爆震伤、颅脑损伤和骨折等;所有伤者均存在烧伤,平均烧伤面积为（92±14）％体表面积（TBSA）,其中深Ⅱ度烧伤占（14±10）％ TBSA,Ⅲ度烧伤占（77±19）％ TBSA;病程中34例（85.0％）伤者出现多器官功能不全综合征（MODS）,主要累及呼吸、循环、肝脏、胃肠道、肾脏及凝血功能;患者住院期间最常见的感染部位为创面、血液及肺,致病菌主要为革兰阴性菌（占91.3％）,前5位致病菌分别为奇异变形杆菌、鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、阴沟肠杆菌;积极救治后28 d死亡8例（病死率20.0％）,90d死亡25例（病死率62.5％）,主要死亡原因是感染性休克及MODS.结论 昆山“8·2”爆炸事故现场存活者主要呈大面积烧伤,以Ⅲ度烧伤为主,病程中多数伤者出现多器官功能不全综合征及合并感染.Objective To retrospectively analyze the injury features of survived casualties and treatment strategies in the explosion accident on 2 August 2014 in Kunshan city （ Kunshan ＂August 2＂ explosion accident）. Methods A total of 40 survived victims in Kunshan ＂August 2＂ Explosion Accident were studied retrospectively. The age, gender, type of injury, burned extent and depth of the patients were recorded. Data of organ function, infection sites and strains of bacteria, treatment strategies and prognosis of the burned victims were analyzed. Results （ 1 ） A total of 40 victims were admitted to our hospital after the explosion accident on 2 August 2014 in Kunshan city, including 28 males and 12 females. （2） The major injury types included burn injury, inhalation injury, blast injury （lung, eye, eardrum, etc）, traumatic brain injury and bone fractures. （3） All victims suffered from burn injury caused by the explosion. The mean burned extent in the survived victims accounted for （92 ± 14）% of total body surface （TBS） and the burned surface with I]I degree accounted for （77± 19） % of TBS. Additionally, incidence of inhalation injury was 97.5%. （4） There were 34 victims were complicated by multiple organ dysfunction syndrome which accounted for 85.0%. The most common organ dysfunction of survived casualties included lungs, cardiovascular system, liver, gastrointestinal tract, kidney, and blood coagulation. （ 5 ） During hospitalization, the most common infectious site in survived casualties was burned skin, followed by blood and lung. The most common infectious strain of bacteria was Gram negative bacteria which accounted for 91.3%. Further analysis showed that Proteus mirabilis was leading pathogen, followed by Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumonia and Enterobacter cloacae. （6） After metictdous treatment, the mean 28-day mortality was 20. 0% and 90-day mortality was 62. 5%, mainly due to septic shock and multiple organ dysfunction syndrome.

关 键 词：昆山“8·2”爆炸事故 烧伤 肺爆震伤 多器官功能不全综合征 感染 

分 类 号：R644[医药卫生—外科学]