早期运用烧伤关键性治疗技术及损伤控制性手术措施对提高火药爆炸烧伤患者存活率的作用  

Curative effect of early use of key treatment strategy for burn injury combined with damage control surgery on improving the survival rate in burn patients injured by gunpowder explosion

作　　者：焦献功[1] 卢秋成[1] 蒋章佳[1] 杨磊[1] 刘友红[1] 涂赤辉[1] 周阳[1] 张刚[1] 李锋[1] 欧阳显文 周杰民[1] 罗瞳[1] 卢显冬 李红[1] 陈红建[1] 夏珍[1] 周仁花 

机构地区：[1]湖南省浏阳市人民医院烧伤整形外科,湖南浏阳410300

出　　处：《感染．炎症．修复》2015年第3期157-161,共5页Infection Inflammation Repair

基　　金：卫生行业科研专项项目(201202002)

摘　　要：目的:探讨应用烧伤关键性治疗技术加损伤控制技术(DCS)对火药爆炸烧伤患者治疗效果的影响。方法:我科2011年1月—2014年12月2 760例火药爆炸烧伤患者的治疗分为2个阶段,前阶段(组1,2011年1月—2012年12月)1 466例患者采用烧伤休克复苏和细胞保护、吸入性损伤综合防治、早期营养支持与代谢调理、早期创面修复、脓毒症综合防治等烧伤关键性治疗技术;后阶段(组2,2013年1月—2014年12月)1 294例患者加用DCS措施,即患者不具备创面早期修复的条件时暂缓手术,先维持生命;手术可分批次进行,采取简单的手术,减轻损伤、控制出血。比较2个阶段患者的全身性感染发生率、内脏并发症发生率及存活率。结果:与前阶段比较,后阶段治疗患者中烧伤面积>50%TBSA患者的全身性感染发生率、内脏并发症发生率(消化道出血、急性肾衰竭、肺功能衰竭、心功能衰竭)、存活率均显著提高(P<0.05)。结论:早期运用烧伤关键性治疗技术加DCS措施对提高火药爆炸烧伤患者的存活率起了重要作用。Objective:To investigate the effect of key treatment strategy for burn injury combined with damage control surgery(DCS) in the treatment of patients with burn injury produced by gunpowder explosion. Methods: Two thousand seven hundred and sixty burn patients injured due to gunpowder explosion admitted to our department from January 2011 to December 2014, were involved in this study, and they were divided into two groups according to two treatment periods. Patients in group 1, who were admitted from January 2011 to December 2012 were treated with ordinary strategy for burn injury, including shock resuscitation, cell protection, comprehensive prevention and treatment of inhalation injury, early nutrition support and metabolic control, early burn wound repair, the prevention and control of sepsis, and other classical treatment. In patients of group 2, who were admitted from January 2013 to December 2014, in addition to classical treatment for burn, DCS was applied. In these patients, surgical treatment was postponed until life was assured, and DCS strategy was practised. Surgery for wound repair was carried out in stages, and simple surgical procedure was carried out at the early stage to reduce damage and loss of blood. The incidence of systemic infection, visceral complications, and survival rate were compared between the 2 groups. Results: Compared with the group 1, incidence of systemic infection, visceral complications(including gastrointestinal bleeding, acute renal failure, pulmonary failure, heart failure) and survival rates were significantly higher in the group 2 in patients with burn area>50% TBSA(P<0.05). Conclusions: The early use of the key strategy for treatment of burn combined with DCS could result an higher survival rate in severe burn patients produced by gunpowder explosion.

关 键 词：烧伤 治疗技术 损伤控制性手术 存活率 

分 类 号：R641[医药卫生—外科学]