Leung C M, Lee S T
Department of Plastic Surgery, Singapore General Hospital.
Ann Acad Med Singap. 1992 Sep;21(5):619-23.
A prospective study of 240 consecutive admissions with respiratory burns over an eight-year period beginning 1982 was carried out at the National Burns Centre, Singapore General Hospital. Diagnosis of respiratory burns was based on clinical criteria and a clinical score was then computed to grade the severity. Investigations included chest x-rays, blood gases, carboxyhaemoglobin level, lung scan and fibreoptic bronchoscopy. Treatment was carried out according to a standard protocol where a policy of early intervention in the form of endotracheal intubation was emphasised. Other respiratory support measures were chest physiotherapy, tracheobronchial suction, mucolytics and bronchoscopic lavage where indicated. We found that respiratory burns was a significant cause of mortality in burns patients. The influence on mortality was most marked in patients with large body surface area burns of more than 40%. Age was also an important determinant of survival with patients older than 50 years faring significantly worse. The routine steroids and prophylactic antibiotics did not influence the survival rate. Carbon monoxide poisoning was not a significant cause of mortality. We achieved an overall mortality rate of 18.3%, with 44 deaths out of 240 patients. The main causes of deaths at post-mortem were bronchopneumonia, septicaemia and extensive burns.
1982年起的八年间，新加坡中央医院国家烧伤中心对连续收治的240例呼吸道烧伤患者进行了一项前瞻性研究。呼吸道烧伤的诊断基于临床标准，然后计算临床评分以评估严重程度。检查包括胸部X光、血气分析、碳氧血红蛋白水平、肺部扫描和纤维支气管镜检查。治疗按照标准方案进行，强调以气管插管形式进行早期干预的策略。其他呼吸支持措施包括胸部物理治疗、气管支气管吸引、黏液溶解剂以及必要时的支气管镜灌洗。我们发现呼吸道烧伤是烧伤患者死亡的重要原因。对死亡率的影响在烧伤面积超过40%的大面积烧伤患者中最为明显。年龄也是生存的重要决定因素，50岁以上患者的情况明显更差。常规使用的类固醇和预防性抗生素对生存率没有影响。一氧化碳中毒不是死亡的重要原因。我们的总死亡率为18.3%，240例患者中有44例死亡。尸检时的主要死亡原因是支气管肺炎、败血症和大面积烧伤。
