Tredget E E, Shankowsky H A, Taerum T V, Moysa G L, Alton J D
Firefighters' Burn Treatment Unit, University of Alberta, Edmonton, Canada.
Ann Surg. 1990 Dec;212(6):720-7. doi: 10.1097/00000658-199012000-00011.
From 1977 to 1987, 1705 thermally injured patients were admitted to the Firefighters' Burn Center at the University of Alberta Hospitals. Thirteen hundred forty-four were male (78.8%) and 361 were female (21.2%), with a mean total burn surface area (TBSA) of 15.1 (SEM +/- 0.4%) and a range of 1% to 99% TBSA. Sixteen hundred thirty-five patients survived to be discharged from hospital, with an overall survival rate of 95.9%. One hundred twenty-four burn patients (7.3%) suffered concomitant inhalation injury diagnosed by bronchoscopy. Patients with inhalation injury suffered from larger TBSA (39.7% +/- 2.8% versus 12.2% +/- 0.3%; p less than 0.01) than those without inhalation injury. Inhalation injury increased the number of deaths from burn injury (34.7% versus 1.7%; p less than 0.01) independent of age and TBSA. Inhalation injury was associated with a threefold prolongation of hospital stay (23.7 +/- 0.7 versus 74.4 +/- 6.2 days; p less than 0.01) and was independent of age and TBSA. Multifactorial probit analysis was performed for both inhalation- and noninhalation-injured burned patients to allow TBSA and age adjusted rates of mortality for the burn population presented. The maximum detrimental effects of inhalation injury in burn patient outcome occurred when it coexisted with moderate (15% to 29% TBSA) to large (30% to 69% TBSA) thermal injuries. These data demonstrate that inhalation injury is an important comorbid factor in burn injury that increases the number of deaths substantially. Most importantly such injuries also independently prolong the duration of hospitalization in a highly unpredictable fashion as compared to patients with cutaneous burns only. As such our data illustrate the extreme importance of inhalation injury as a comorbid factor following thermal injury and reveal the present limitations for accurate quantification of the magnitude of respiratory tract injury accompanying thermal trauma.
1977年至1987年期间，1705名热烧伤患者被收治于阿尔伯塔大学医院的消防员烧伤中心。其中1344名男性（78.8%），361名女性（21.2%），平均烧伤总面积（TBSA）为15.1（标准误±0.4%），范围为1%至99%TBSA。1635名患者存活并出院，总生存率为95.9%。124名烧伤患者（7.3%）经支气管镜检查诊断合并吸入性损伤。与未发生吸入性损伤的患者相比，发生吸入性损伤的患者烧伤总面积更大（39.7%±2.8%对12.2%±0.3%；p<0.01）。吸入性损伤增加了烧伤死亡人数（34.7%对1.7%；p<0.01），且与年龄和TBSA无关。吸入性损伤使住院时间延长了三倍（23.7±0.7天对74.4±6.2天；p<0.01），且与年龄和TBSA无关。对发生和未发生吸入性损伤的烧伤患者均进行了多因素概率分析，以得出调整了TBSA和年龄后的烧伤人群死亡率。当吸入性损伤与中度（15%至29%TBSA）至重度（30%至69%TBSA）热烧伤并存时，对烧伤患者预后的不利影响最大。这些数据表明，吸入性损伤是烧伤中的一个重要合并因素，会大幅增加死亡人数。最重要的是，与仅皮肤烧伤的患者相比，此类损伤还会以高度不可预测的方式独立延长住院时间。因此，我们的数据说明了吸入性损伤作为热损伤后合并因素的极端重要性，并揭示了目前准确量化热创伤伴发呼吸道损伤程度的局限性。
