烫伤与火焰烧伤的临床结局、炎症和高代谢是否存在差异？
Is there a difference in clinical outcomes, inflammation, and hypermetabolism between scald and flame burn?
机构信息
Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
出版信息
Pediatr Crit Care Med. 2011 Nov;12(6):e275-81. doi: 10.1097/PCC.0b013e31820ac2c5.
OBJECTIVE
Severe thermal injury induces inflammatory and hypermetabolic responses that are associated with morbidity and mortality. However, it is not well-documented whether the causes of burns affect inflammation, hypermetabolism, and morbidity. The aim of the present study was to determine whether there is a difference in degree of inflammation, hypermetabolism, endocrine and acute-phase response, and clinical outcome between pediatric patients with scald and flame burns.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Children with burns requiring surgical intervention were enrolled in this cohort study and divided into two groups, scald or flame burn. In a second assignment, we analyzed the study populations in representative subgroups containing individuals with third-degree burns of 40% to 60% total body surface area. We determined clinical outcomes, resting energy expenditures, cytokine profiles, acute-phase proteins, constitutive proteins, and hormone panels. Statistical analysis was evaluated by analysis of variance, Student's t test corrected with the Bonferroni post hoc test, and the propensity score. Statistical significance was set at p < .05. A total of 912 patients were identified. Six hundred seventy-four had a flame burn and 238 had a scald burn. There was a significant difference (p < .05) in burn size (flame, 48% ± 23%; scald, 40% ± 21%), third-degree burn (flame, 39% ± 27%; scald 22% ± 25%), age (flame, 8 ± 5 yrs; scald, 3 ± 3 yrs), and mortality between groups. Propensity analysis confirmed the type of burn as a significant risk factor for morbidity and mortality. Subanalysis conducted in a representative patient group suffering from 40% to 60% burn total body surface area revealed that flame burns lead to significantly increased hypermetabolic, inflammatory, and acute-phase responses when compared to scald burns (p < .05). The frequency of sepsis was 3% in the scald burn group, while it was 14% in the flame group (p < .001). Multiorgan failure occurred in 14% of the scald patients, while it occurred in 17% of flame patients. The mortality in patients suffering from a scald burn was 3% compared to 6% in the flame-burned group (p < .05).
CONCLUSION
The type of burn affects hypermetabolism, inflammation, acute-phase responses, and mortality postburn.
目的
严重的热损伤会引起炎症和高代谢反应，从而导致发病率和死亡率升高。然而，烧伤原因是否会影响炎症、高代谢、内分泌和急性期反应以及临床结果，目前还没有很好的记录。本研究的目的是确定小儿烫伤和火焰烧伤患者之间的炎症、高代谢、内分泌和急性期反应程度以及临床结局是否存在差异。
干预措施
无。
测量和主要结果
本队列研究纳入了需要手术干预的烧伤患儿，并将其分为两组，即烫伤或火焰烧伤。在第二项任务中，我们在含有 40%至 60%总体表面积三度烧伤的代表性亚组中分析了研究人群。我们确定了临床结果、静息能量消耗、细胞因子谱、急性期蛋白、结构蛋白和激素谱。采用方差分析、经 Bonferroni 事后检验校正的 Student's t 检验和倾向评分进行统计分析。统计学意义设为 p <.05。共确定了 912 例患者。674 例为火焰烧伤，238 例为烫伤。两组间烧伤面积（火焰烧伤 48%±23%；烫伤 40%±21%）、三度烧伤（火焰烧伤 39%±27%；烫伤 22%±25%）、年龄（火焰烧伤 8±5 岁；烫伤 3±3 岁）和死亡率均存在显著差异（p <.05）。倾向分析证实烧伤类型是发病率和死亡率的显著危险因素。在一个患有 40%至 60%总体表面积烧伤的代表性患者亚组中进行的亚组分析显示，与烫伤烧伤相比，火焰烧伤导致明显增加的高代谢、炎症和急性期反应（p <.05）。烫伤烧伤组的脓毒症发生率为 3%，而火焰烧伤组为 14%（p <.001）。多发器官功能衰竭在烫伤患者中发生率为 14%，在火焰患者中发生率为 17%。烫伤烧伤患者的死亡率为 3%，而火焰烧伤患者的死亡率为 6%（p <.05）。
结论
烧伤类型影响烧伤后高代谢、炎症、急性期反应和死亡率。
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