Neaman Keith C, Andres L Albert, McClure Amanda M, Burton Michael E, Kemmeter Paul R, Ford Ronald D
Grand Rapids Medical Education and Research Center/Michigan State University Plastic Surgery Residency, Grand Rapids, Michigan 49503, USA.
J Burn Care Res. 2011 May-Jun;32(3):421-8. doi: 10.1097/BCR.0b013e318217f8c6.
An accurate measurement of BSA involved in patients injured by burns is critical in determining initial fluid requirements, nutritional needs, and criteria for tertiary center admissions. The rule of nines and the Lund-Browder chart are commonly used to calculate the BSA involved. However, their accuracy in all patient populations, namely obese patients, remains to be proven. Detailed BSA measurements were obtained from 163 adult patients according to linear formulas defined previously for individual body segments. Patients were then grouped based on body mass index (BMI). The contribution of individual body segments to the TBSA was determined based on BMI, and the validity of existing measurement tools was examined. Significant errors were found when comparing all groups with the rule of nines, which overestimated the contribution of the head and arms to the TBSA while underestimating the trunk and legs for all BMI groups. A new rule is proposed to minimize error, assigning 5% of the TBSA to the head and 15% of the TBSA to the arms across all BMI groups, while alternating the contribution of the trunk/legs as follows: normal-weight 35/45%, obese 40/40%, and morbidly obese 45/35%. Current modalities used to determine BSA burned are subject to significant errors, which are magnified as BMI increases. This new method provides increased accuracy in estimating the BSA involved in patients with burn injury regardless of BMI.
准确测量烧伤患者的体表面积（BSA）对于确定初始液体需求量、营养需求以及三级中心收治标准至关重要。常用九分法和伦德-布劳德图表来计算烧伤面积。然而，它们在所有患者群体（即肥胖患者）中的准确性仍有待证实。根据先前为各个身体部位定义的线性公式，对163名成年患者进行了详细的体表面积测量。然后根据体重指数（BMI）对患者进行分组。根据BMI确定各个身体部位对总体表面积（TBSA）的贡献，并检验现有测量工具的有效性。将所有组与九分法进行比较时发现了显著误差，九分法高估了头部和手臂对TBSA的贡献，而低估了所有BMI组中躯干和腿部的贡献。提出了一条新规则以尽量减少误差，在所有BMI组中，将TBSA的5%分配给头部，15%分配给手臂，同时躯干/腿部的贡献交替如下：正常体重者为35/45%，肥胖者为40/40%，病态肥胖者为45/35%。目前用于确定烧伤体表面积的方法存在显著误差，且随着BMI的增加而放大。这种新方法在估计烧伤患者的体表面积时，无论BMI如何，都能提高准确性。
