Thamm Oliver C, Perbix Walter, Zinser Max J, Koenen Paola, Wafaisade Arasch, Maegele Marc, Lefering Rolf, Neugebauer Edmund A, Theodorou Panagiotis
Clinic for Plastic- and Reconstructive Surgery, Handsurgery, Burn Care Center, University of Witten/Herdecke, Cologne-Merheim Medical Center, Ostmerheimer Straße 200, 51109 Köln, Germany.
Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center, Ostmerheimer Straße 200, 51109 Köln, Germany.
Burns. 2013 Aug;39(5):935-41. doi: 10.1016/j.burns.2012.10.007. Epub 2012 Nov 10.
BACKGROUND AND OBJECTIVES: Inhalation injury, especially in combination with cutaneous burns, is the major cause of morbidity and mortality in patients admitted to burn care centers. Either with or without the presence of a cutaneous burn, inhalation injury contributes to high risk for developing severe pulmonary complications. Steroids may reduce a prolonged and destructive inflammatory response to toxic or allergic substances. The objective of this study was to evaluate the effect of early single-shot intravenous steroids on pulmonary complications and mortality in burned or scalded patients with or without inhalation injury. METHODS: Retrospective analysis of a prospective single center database of patients registered between 1989 and 2011 who were admitted to the intensive care unit of our burn care center after burn or scald injury. Uni-variate statistical analysis was performed comparing two groups (steroid treated vs. non steroid treated patients) with regard to clinical outcome. Main parameters were sepsis, mortality and pulmonary complications such as pneumonia, ALI and ARDS. Multi-variate analysis was used by logistic regression with mortality and pulmonary complications as the dependent variables to identify independent risk factors after burn or scald injuries. RESULTS: A total of 1637 patients with complete data were included in the present analysis. 199 (12.2%) received single-shot intravenous steroids during the prehospital phase of care. In 133 (66.8%) of these patients, inhalation injury was diagnosed via bronchoscopy. Steroid treated patients had sustained a significantly higher severity of burn than non-steroid treated patients (Abbreviated Burn Severity Index 7.1±3 vs. 6.0±2.9; p<0.001). In a multivariate analysis using a logistic regression model early intravenous steroid treatment had no significant effect on pulmonary complications and mortality. CONCLUSIONS: In our single center cohort of burned and scalded patients single-shot intravenous steroids during the pre-hospital phase of care was not associated with pulmonary complications or mortality.
背景与目的：吸入性损伤，尤其是合并皮肤烧伤时，是烧伤治疗中心收治患者发病和死亡的主要原因。无论有无皮肤烧伤，吸入性损伤都会增加发生严重肺部并发症的风险。类固醇可能会减轻对有毒或过敏物质的长期破坏性炎症反应。本研究的目的是评估早期单次静脉注射类固醇对有或无吸入性损伤的烧伤或烫伤患者肺部并发症及死亡率 的影响。 方法：回顾性分析1989年至2011年间登记的前瞻性单中心数据库，这些患者在烧伤或烫伤后入住我们烧伤治疗中心重症监护病房。对两组（接受类固醇治疗的患者与未接受类固醇治疗的患者）的临床结局进行单变量统计分析。主要参数为脓毒症、死亡率和肺部并发症，如肺炎、急性肺损伤和急性呼吸窘迫综合征。采用多变量分析，以死亡率和肺部并发症为因变量进行逻辑回归，以确定烧伤或烫伤后的独立危险因素。 结果：本分析共纳入1637例数据完整的患者。199例（12.2%）在院前护理阶段接受了单次静脉注射类固醇。其中133例（66.8%）患者经支气管镜检查诊断为吸入性损伤。接受类固醇治疗的患者烧伤严重程度明显高于未接受类固醇治疗的患者（简化烧伤严重指数分别为7.1±3和6.0±2.9；p<0.001）。在使用逻辑回归模型的多变量分析中，早期静脉注射类固醇治疗对肺部并发症和死亡率无显著影响。 结论：在我们单中心的烧伤和烫伤患者队列中，院前护理阶段的单次静脉注射类固醇与肺部并发症或死亡率无关。
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