Division of Plastic Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.
Burns. 2012 Mar;38(2):203-7. doi: 10.1016/j.burns.2011.08.010. Epub 2011 Oct 1.
Inhalation injuries contribute significantly to morbidity and mortality in both children and adults with burns. Pneumonia is a major compromising factor in these patients. The purpose of this article was to evaluate the characteristics, impact factors, incidence, morbidity, and mortality of pneumonia in inhalation injuries. Furthermore, a severity score has been formulated to help predict the probability of developing pneumonia following inhalation injuries. A retrospective study was performed of 214 patients, treated for inhalation injuries from 1999 to 2009 at the Burn Center in Chang Gung Memorial Hospital, Linkou, Taiwan. Patients' characteristics, length of hospitalization, total burn surface area, initial PaO2:FiO2 ratio, number of intubated days, bronchoscope grade, initial carboxyhemoglobin level (COHb) and mortality rate were recorded. A Student's t-test was used for comparison of inhalation injury patients with and without pneumonia and was also used for comparing a TBSA of >20% to those with a TBSA of ≤20% in patients with inhalation injury and pneumonia. Logistic regression analyses were utilized to create a severity score related to pneumonia. 129 patients with inhalation injury were included in the analysis. Overall, 38% (49/129) patients developed pneumonia. Pneumonia associated with inhalation injury occurred more often in patients with a TBSA>20% (P<0.05). The intubation days, bronchoscope grade and COHb level of pneumonia patients were significantly longer (P<0.05). Initial PaO2:FiO2 ratio (PaO2/FiO2) was significantly lower in patients with pneumonia (P<0.05). Mortality following pneumonia was increased sevenfold (P<0.05). Hospitalization days and intubation days were significantly longer in TBSA>20%. Logistic regression analysis was performed to find out the impact factors of pneumonia in inhalation injury patients and to set a severity score. Patients age >60 years, TBSA >20%, bronchoscope grade is 3 or 4, initial PaO2/FiO2≦300 and initial COHb level>10% showed a significant difference (P<0.05). The total severity scale was set at 5 points. Each impact factor was given one point and when the score ≥2 it means patients have high risk of development of pneumonia. This study had identified the significant risk factors for potential development of pneumonia in a group of inhalation injury patients. The impact of these risk factors should be validated in further prospective trials to improve outcome or at least reduce the incidence of the surrogate diagnosis of pneumonia.
吸入性损伤在儿童和成人烧伤患者的发病率和死亡率中都占有重要地位。肺炎是这些患者的主要并发症。本文旨在评估吸入性损伤后肺炎的特征、影响因素、发病率、患病率和死亡率。此外，还制定了严重程度评分，以帮助预测吸入性损伤后发生肺炎的概率。对 1999 年至 2009 年在台湾林口长庚纪念医院烧伤中心接受吸入性损伤治疗的 214 例患者进行了回顾性研究。记录了患者的特征、住院时间、总烧伤面积、初始 PaO2:FiO2 比值、插管天数、支气管镜分级、初始碳氧血红蛋白水平（COHb）和死亡率。采用学生 t 检验比较吸入性损伤患者和无肺炎患者，并比较吸入性损伤和肺炎患者中 TBSA>20%和 TBSA≤20%患者之间的差异。利用 logistic 回归分析创建与肺炎相关的严重程度评分。纳入 129 例吸入性损伤患者进行分析。总体而言，38%（49/129）的患者发生肺炎。TBSA>20%的患者更易发生与吸入性损伤相关的肺炎（P<0.05）。肺炎患者的插管天数、支气管镜分级和 COHb 水平明显延长（P<0.05）。肺炎患者的初始 PaO2:FiO2 比值（PaO2/FiO2）明显降低（P<0.05）。肺炎后死亡率增加了 7 倍（P<0.05）。TBSA>20%的患者住院时间和插管时间明显延长。进行 logistic 回归分析以找出吸入性损伤患者肺炎的影响因素，并制定严重程度评分。年龄>60 岁、TBSA>20%、支气管镜分级为 3 或 4、初始 PaO2/FiO2≦300 和初始 COHb 水平>10%的患者差异有统计学意义（P<0.05）。总严重程度评分设定为 5 分。每个影响因素得 1 分，当得分≥2 时，表示患者发生肺炎的风险较高。本研究确定了一组吸入性损伤患者发生肺炎的潜在危险因素。这些危险因素的影响应在进一步的前瞻性试验中得到验证，以改善结果或至少降低肺炎替代诊断的发生率。
