Anzarut Alexander, Chen Matthew, Shankowsky Heather, Tredget Edward E
Division of Plastic Surgery and Critical Care Medicine, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Plast Reconstr Surg. 2005 Sep;116(3):791-7. doi: 10.1097/01.prs.0000176257.22583.4b.
Quality of life is a major criterion when decisions regarding resuscitation, reconstruction, and rehabilitation of patients with massive burn injuries are being considered. There has been little research focusing on quality of life following burn injuries involving more than 50 percent total body surface area in the adult population. The authors' goals were to describe quality of life and identify specific clinical and functional indices that predict good quality of life following massive burn injuries.
Using a prospective study design, 47 patients who survived a massive burn between 1980 and 2001 were recruited from a single burn unit. Clinical data were collected from hospital records, function was assessed using the Abbreviated Burn-Specific Health Scale, and quality of life was assessed using the Short Form-36 survey. The Short Form-36 scores were compared with population norms. Univariate and multivariate regression analyses were used to identify factors predicting Short Form-36 scores.
Overall, the mean age was 28 +/- 1.8 years, 96 percent (45 of 47) were men, and the mean burn size was 64 +/- 2.1 percent total body surface area. Compared with Canadian population norms, burn patients had significantly lower Short Form-36 scores in the domains of role physical (69.1 versus 82.1, p = 0.0067) and general health perception (67.2 versus 77.0, p = 0.00014). At the time of injury, the amount of total full-thickness burn predicted follow-up Short Form-36 physical summary scores (R2 = 15 percent, p < 0.001). At the time of follow-up, addition of the patient's hand function significantly contributed to the prediction of Short Form-36 physical summary scores (R2 = 44 percent, p < 0.001). At the time of injury, the age of the patient predicted follow-up Short Form-36 mental summary scores (R2 = 25 percent, p < 0.001). At the time of follow-up, addition of the patient's perceived level of social support significantly contributed to the prediction of Short Form-36 mental summary scores (R2 = 44 percent, p < 0.001).
Survivors of massive burn injury reported a good quality of life in most Short Form-36 domains. The authors identified the size of the total full-thickness injury and the age of the patient as factors available at the time of injury that predict quality of life. The addition of hand function and the patient's perceived level of social support at the time of follow-up improved prediction of quality of life. Accordingly, this information on quality of life after massive burn injury could aid in decision making at the time of resuscitation, reconstruction, and rehabilitation.
在考虑对大面积烧伤患者进行复苏、重建和康复决策时，生活质量是一个主要标准。在成年人群中，很少有研究关注全身表面积超过50%的烧伤后的生活质量。作者的目标是描述生活质量，并确定预测大面积烧伤后良好生活质量的特定临床和功能指标。
采用前瞻性研究设计，从一个烧伤病房招募了1980年至2001年间在大面积烧伤中存活的47名患者。从医院记录中收集临床数据，使用简化烧伤特异性健康量表评估功能，并使用简短健康调查问卷36项版本评估生活质量。将简短健康调查问卷36项版本的得分与人群常模进行比较。采用单因素和多因素回归分析来确定预测简短健康调查问卷36项版本得分的因素。
总体而言，平均年龄为28±1.8岁，96%（47名中的45名）为男性，平均烧伤面积为全身表面积的64±2.1%。与加拿大人群常模相比，烧伤患者在角色身体功能（69.1对82.1，p = 0.0067）和总体健康感知（67.2对77.0，p = 0.00014）领域的简短健康调查问卷36项版本得分显著更低。受伤时，全层烧伤的面积可预测随访时简短健康调查问卷36项版本身体总结得分（R2 = 15%，p < 0.001）。随访时，患者的手部功能对简短健康调查问卷36项版本身体总结得分的预测有显著贡献（R2 = 44%，p < 0.001）。受伤时，患者的年龄可预测随访时简短健康调查问卷36项版本心理总结得分（R2 = 25%，p < 0.001）。随访时，患者感知到的社会支持水平对简短健康调查问卷36项版本心理总结得分的预测有显著贡献（R2 = 44%，p < 0.001）。
大面积烧伤幸存者在大多数简短健康调查问卷36项版本领域报告了良好的生活质量。作者确定了全层损伤的面积和患者的年龄作为受伤时可预测生活质量的因素。随访时增加手部功能和患者感知到的社会支持水平可改善对生活质量的预测。因此，这些关于大面积烧伤后生活质量的信息有助于在复苏、重建和康复时做出决策。
