成批爆炸烧冲复合伤的救治  

Treatment of batch exploding burn-blast combined injury

作　　者：雷晋[1] 段鹏[1] 郝振明[1] 明志国[1] 冯晋斌 李明森[3] 

机构地区：[1]山西医科大学附属太钢总医院烧伤整形科(山西省烧伤救治中心),太原030009 [2]解放军第二六四医院烧伤科,太原030001 [3]太原市第二人民医院烧伤整形美容科,030002

出　　处：《中华损伤与修复杂志（电子版）》2015年第3期33-36,共4页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的总结2012年11月23日寿阳某火锅店成批烧冲复合伤的救治经验，为公共突发爆炸事件的临床救治提供新的思路。方法分析本次事件中各级政府应急预案实施及指挥协调情况，对转入省城3所医院的33例患者，早期救治高度重视烧冲复合伤特点，制定总体治疗方案。所有患者行动脉血气分析及经皮氧饱和度动态监测；胸部x线片动态观察其影像学变化；适时进行胸部CT检查；动态监测D-二聚体、血凝系列，合理应用止血药物及抗凝药物等。针对烧伤除按照早期抗休克、脏器保护措施、抗感染、及时创面处理等救治原则及常规治疗外，重点针对肺爆震伤采取了“集束化”治疗方案；有吸入性损伤患者行纤维支气管镜诊治。从伤后3d开始，根据病情，有计划、分批次地进行创面切、削痂，自体皮移植；伤后5～7d，针对肺爆震伤较重的12例患者，在呼吸机支持下，行创面切、削痂、自体皮Meek植皮术。结果采用“集束化”治疗方案，诊断为不同程度爆震伤患者于伤后1周，胸腔积液及肺部斑片状浸润性病灶逐渐吸收。伤后1个月，CT检查提示2例患者肺部轻度纤维化，肺功能检查显示通换气功能基本正常。33例患者烧伤创面于伤后3～4周愈合，所有患者均救治成功，无一例死亡。结论建立完善的应急响应机制及预案，重视和健全省、市、县三级医疗救治网络体系至关重要。高度重视成批爆震伤伤员现场的有序救治和及时、合理分流。把握烧冲复合伤的特点，对烧冲复合伤成批伤员进行院内救治。重视烧伤救治的同时，高度重视肺爆震伤“隐匿性与爆发性”的特点，采取“集束化”救治措施，能有效控制和减轻肺爆震伤损伤程度并提高成批烧冲复合伤救治的成功率。Objective To summarize the medical experience of the treatment of batch burn-blast combined injury at Shouyang hotpot restaurant on November 23, 2012 and provide new ideas for clinical treatment of public emergencies. Methods The implementation of contingency plans and command coordination of all levels of government in the emergency were analyzed. For the 33 patients transferred to provincial capital of 3 hospitals, more attention to characteristics of the early treatment of burn-blast combined injury was paid and an overall treatment plan was planned. All the patients carried out arterial blood gas analysis and transcntaneous oxygen saturation monitoring, chest X ray film imaging dynamic observation variable, chest CT examination timely, reasonable application dynamic monitoring D-dimer and series of coagulation, hemostatic drugs and the anticoagulant drugs, and so on. In addition anti-shock, anti-infection, viscera protection measures, timely wounds treatment principles of treatment and conventional treatment in early stage of burn, the authors focused on burn-blast combined injury and adopted a cluster control measure. Patients with inhalation injury were diagnosed and treatmented with fiberoptic bronchoscopy. For the first 3 days after injury, according to the condition, the wound scab was cutted, pared and autologous skin grafts designedly and in batches. Twelve patients of burst injury of lung seriously with ventilator support were operated by cutting wound scab, Meek skin grafting for 5-7 days after the injury. Twelve patients completed the tracheostomy tube insertion within 4 h after injury. Results Pleural effusion and pulmonary patchy infiltrates lesions oven were absorbed gradually for the patients which were diagnosed with blast injury in different degree by cluster control measures at one week after injury. CT examination clew： 2 cases of patients with mild lung fibrosis, pulmonary function examination, basic normal ventilation function at one month after injury. Thirty-three patients with burn wo

关 键 词：烧伤 公共突发事件 爆炸伤 烧冲复合伤 集束化治疗 

分 类 号：R644[医药卫生—外科学]