252例严重烧伤患者心肌损伤情况的回顾性研究  

作　　者：张灿[1] 张均辉 张东霞[1] 谢卫国[2] 蒋章佳[3] 林国安 牛希华[5] 黄跌生 

机构地区：[1]第三军医大学西南医院全军烧伤研究所,创伤、烧伤与复合伤国家重点实验室,重庆400038 [2]武汉大学同仁医院暨武汉市第三医院烧伤科 [3]浏阳市人民医院烧伤整形外科 [4]解放军第一五九中心医院全军烧伤中心 [5]河南大学附属郑州市第一人民医院烧伤科

出　　处：《中华烧伤杂志》2016年第5期260-265,共6页Chinese Journal of Burns

摘　　要：目的回顾性分析严重烧伤患者发生心肌损伤的危险因素及临床表现，为其防治提供依据。方法2010年1月-2015年6月，5家笔者单位收治符合入选标准的252例严重烧伤患者，按第三军医大学补液公式进行液体复苏。根据入院时治疗前心肌型肌酸激酶同工酶（CK-MB）水平，将患者分为非心肌损伤组（CK-MB〈75U／mL）118例和心肌损伤组（CK-MB≥75U／mL）134例。统计2组患者性别、年龄、体质量、化学烧伤例数、伤后入院时间、烧伤总面积、Ⅲ度面积、吸入性损伤例数，入院时及伤后24、48hHb、血细胞比容、血乳酸，伤后24、48h尿量、补液量，入院时及伤后24、48h肌酐、尿素氮、总胆汁酸、二胺氧化酶水平，病死率。另外将患者按照烧伤总面积分为3组：小于50％TBSA组110例、大于或等于50％TBSA且小于80％TBSA组83例、大于或等于80％TBSA组59例，统计3组患者心肌损伤发生率。对数据行X2检验、t检验、Wilcoxon检验、重复测量方差分析，并进行Bonferroni校正。对252例患者基本资料行二分类logistic回归分析，筛选心肌损伤的独立危险因素；绘制252例患者烧伤总面积的受试者工作特征曲线，评估其对心肌损伤发生的预测效果。结果（1）2组患者年龄、体质量、化学烧伤例数、吸入性损伤例数、Ⅲ度面积比较，差异不明显（t值分刖为0．20、0．31，X2值分别为0．49、4．10，Z=1．42，P值均大于0．05）；性别、伤后入院时间、烧伤总面积比较，差异明显（X2=5．00，t值分别为2．44、3．13，P〈0．05或P〈0．01）。（2）性别、伤后入院时间、烧伤总面积是影响患者心肌损伤的独立危险因素（比值比分别为2．608、3．620、1．030，95％置信区间分别为1．315～5．175、1．916～6．839、1．011～1．049，P值均小于0．01）。（3）小于50％TBSA组、大于或等于50％TBSA且小于80％TBSA组、大于或等于80�Objective To retrospectively analyze the risk factors and clinical manifestations of myocardial damage of patients with severe burn in order to provide evidence for its prevention and treatment.Methods Two hundred and fifty-two patients with severe burn admitted to 5 burn centers from January 2010 to June 2015,conforming to the study criteria,were treated in accordance with the fluid resuscitation formula of the Third Military Medical University.According to the creatine kinase isoenzyme-MB (CK-MB) level before treatment on admission,patients were divided into non-myocardial damage group (n =118,CK-MB level less than 75 U/mL) and myocardial damage group (n =134,CK-MB level higher than or equal to 75 U/mL).Data of patients in two groups were collected and evaluated such as gender,age,body mass,number of patients with chemical burn,admission time after injury,total burn area,full-thickness burn area,number of patients with inhalation injury,levels of haemoglobin,hematocrit,and blood lactate on admission and at post injury hour (PIH) 24 and 48,volumes of urine output and fluid input at PIH 24 and 48,levels of creatinine,urea nitrogen,total bile acid,diamine oxidase on admission and at PIH 24 and 48,and mortality.Furthermore,patients were divided into three groups,i.e.less than 50％ total body surface area (TBSA) group (n =110),larger than or equal to 50％ TBSA and less than 80％ TBSA group (n =83),and larger than or equal to 80％ TBSA group (n =59) according to the total burn area,and the incidence rates of myocardial damage in patients of three groups were recorded.Data were processed with chi-square test,t test,Wilcoxon test,analysis of variance for repeated measurement,and the values of P were adjusted by Bonferroni.Basic data of 252 patients were processed with binary logistic regression analysis.Receiver operating characteristic curve of total burn area of 252 patients was drawn to predict myocardial damage.Results (1) There were no statistically significant differences in age,body mass,number of patients w

关 键 词：烧伤 危险因素 死亡率 心肌损伤 

分 类 号：R644[医药卫生—外科学]