1994 - 2004年芬兰儿科重症监护病房收治的烧伤病例 - Suppr

Papp Anthony, Rytkönen Tanja, Koljonen Virve, Vuola Jyrki

Kuopio University Hospital, Burn Unit, Kuopio, Finland.

Burns. 2008 May;34(3):339-44. doi: 10.1016/j.burns.2007.09.002. Epub 2008 Jan 22.

INTRODUCTION

The paediatric burn population requiring intensive care in Finland has never been examined before. The aim of this study was firstly to determine the aetiology, incidence and prognosis of paediatric burns requiring intensive care in Finland and secondly to compare the possible differences between the two national burn centres.

METHODS

All burn patients' charts were retrospectively reviewed in two national burn centres from an 11-year-period. Patients whose ICU stay was more than 48h, were included.

RESULTS

Forty-five children who were hospitalized in the two burn centres during the study period met the inclusion criteria. They represent 2.4% (45/1898) of all burns victims hospitalized in these burn centres during that time giving an incidence of 0.1/100,000 per year in Finland. The median age was 5 years, every third patient was 0-2 years old and 75.6% were male. Most burns were scalds (42.2%), which caused all burns (100%) in age group 0-2 years. Flame burns were most frequent (83%) in the age group 6-10 years. In the 11-16 years old patients, high voltage/electric burns caused 50% of all burns and flame the other 50%. The overall median TBSA in all burns was 26%. The median (range) hospital stay was 12 days (2-193) (0.88 days/% burned) and the median (range) ICU days was 7 (2-64) (0.29 days/%). Intubation and respirator therapy was needed in 31 (46%) patients. There were no patients who needed haemofiltration or haemodialysis and no mortality. Only six patients (13%) were treated conservatively and 39 (87%) surgically. Dressing changes under general anaesthesia were preferred in Helsinki (37 times) and especially in the paediatric hospital (32 times) compared to Kuopio (7 times). Allografts were used only in Helsinki in 4 patients whereas artificial skin was used only in Kuopio in 15 patients. The overall cost of care was very similar in both centres being 1292-1425 euros per hospital day.

CONCLUSIONS

There were some small differences between the two burn centres in treatment policies. Most patients were male and most common aetiology was scald. The prognosis of these patients was excellent with no mortality.

引言

芬兰需要重症监护的儿童烧伤患者群体此前从未被研究过。本研究的目的一是确定芬兰需要重症监护的儿童烧伤的病因、发病率和预后，二是比较两个国家烧伤中心之间可能存在的差异。

方法

对两个国家烧伤中心11年间所有烧伤患者的病历进行回顾性审查。纳入重症监护病房（ICU）住院时间超过48小时的患者。

结果

研究期间在这两个烧伤中心住院的45名儿童符合纳入标准。他们占当时在这些烧伤中心住院的所有烧伤患者的2.4%（45/1898），芬兰每年的发病率为0.1/10万。中位年龄为5岁，每三名患者中有一名年龄在0至2岁之间，75.6%为男性。大多数烧伤为烫伤（42.2%），在0至2岁年龄组中，烫伤导致了所有烧伤（100%）。火焰烧伤在6至10岁年龄组中最为常见（83%）。在11至16岁的患者中，高压/电击烧伤占所有烧伤的50%，火焰烧伤占另外50%。所有烧伤患者的总体中位烧伤总面积（TBSA）为26%。中位（范围）住院时间为12天（2 - 193天）（0.88天/%烧伤），中位（范围）ICU住院天数为7天（2 - 64天）（0.29天/%）。31名（46%）患者需要插管和呼吸机治疗。没有患者需要血液滤过或血液透析，也没有死亡病例。只有6名患者（13%）接受了保守治疗，39名（87%）接受了手术治疗。与库奥皮奥（7次）相比，赫尔辛基（37次），尤其是儿童医院（32次）更倾向于在全身麻醉下进行换药。仅在赫尔辛基，4名患者使用了同种异体移植物，而仅在库奥皮奥，有15名患者使用了人工皮肤。两个中心的总体护理费用非常相似，每天每家医院为1292 - 1425欧元。