Barrow Robert E, Spies Marcus, Barrow Laura N, Herndon David N
Department of Surgery, Shriners Hospitals for Children, The University of Texas Medical Branch, 815 Market Street, Galveston, TX 77550, USA.
Burns. 2004 Feb;30(1):72-7. doi: 10.1016/j.burns.2003.07.003.
Pulmonary failure has emerged as one of the leading causes of mortality in burned children due, in part, to the success in reducing the incidence of sepsis, early surgery and fluid resuscitation, and new advances in nutritional support. To evaluate the effect of pulmonary injury, age, gender, race, and burn size on mortality, the records of 3179 burned children admitted to our burn center from 1985 to 2001 were reviewed. In this population, 1246 were admitted within 14 days of injury with burns greater than 20% of their total body surface area (TBSA).
Lethal burn areas (LAs) for a thermal injury only or burn plus inhalation injury were estimated from best fit probit curve within 95% confidence limits. Data analysis was by chi(2)-test, t-test, or Fisher's exact test where appropriate.
The lethal burn area for a 10% mortality rate with and without concomitant inhalation injury was a 50 and 73% TBSA burn, respectively. Children up to the age of 3 with >/=20% TBSA burns had a higher rate of mortality (9.9%) compared to those 3-12 years of age (4.9%) and 13-18 years of age (4.2%). Children with 21-80% TBSA burns showed a significant difference in mortality (P<0.05) between those with burn plus inhalation injury (13.9%) and burn only (2.9%), while those with 81-100% TBSA burns showed no significant difference between burn only and burn plus inhalation injury.
Inhalation injury remains one of the primary contributors to burn mortality. Children under the age of 3 years, however, are at a higher risk both with and without inhalation injury.
肺功能衰竭已成为烧伤儿童主要死因之一，部分原因是在降低脓毒症发病率、早期手术和液体复苏方面取得成功，以及营养支持方面的新进展。为评估肺损伤、年龄、性别、种族和烧伤面积对死亡率的影响，我们回顾了1985年至2001年收治于我院烧伤中心的3179例烧伤儿童的记录。在这一群体中，1246例在受伤14天内入院，烧伤面积超过其体表面积（TBSA）的20%。
仅热力伤或热力伤加吸入性损伤的致死烧伤面积（LA）通过在95%置信区间内的最佳拟合概率曲线进行估计。数据分析在适当情况下采用卡方检验、t检验或Fisher精确检验。
伴有和不伴有吸入性损伤时，死亡率为10% 的致死烧伤面积分别为50% 和73% 的TBSA烧伤。3岁及以下TBSA烧伤≥20% 的儿童死亡率（9.9%）高于3 - 12岁（4.9%）和13 - 18岁（4.2%）的儿童。TBSA烧伤面积为21% - 80% 的儿童中，伴有吸入性损伤者（13.9%）和仅热力伤者（2.9%）的死亡率有显著差异（P<0.05），而TBSA烧伤面积为81% - 10% 的儿童中，仅热力伤和热力伤加吸入性损伤之间死亡率无显著差异。
吸入性损伤仍然是烧伤死亡的主要原因之一。然而，3岁以下儿童无论有无吸入性损伤，死亡风险都更高。
