Gao Hui, Li Wei, Zhao Yuan-dang
Department of Burns, Fudan University, Shanghai, China.
Zhonghua Shao Shang Za Zhi. 2012 Dec;28(6):411-4.
To investigate the epidemiological factors in the first aid, early management, and treatment of chemical burns.
Medical records of 615 inpatients with chemical burns out of 2682 burn patients hospitalized from January 2001 to December 2010 were screened to retrospectively analyze the clinical data, including gender, age, burn area and depth, occurrence regularity, injury cause, injury-causing chemicals, wound site, complications, pre-hospital management, treatment and prognosis. Annual number of burn patients and annual number of patients with chemical burns were statistically analyzed with linear trend test.
(1) Among all the chemical burn patients, 562 (91.4%) were male and 53 (8.6%) female. The mean age of patients was (32 ± 12) years. Burn area ranged from 1% to 95%, with mean area of (30 ± 25)% TBSA. Full-thickness burn area ranged from 0 to 85%, with mean area of (18 ± 24)% TBSA. (2) The annual number of burn patients showed a slow trend of increase during the last decade (χ(2) = 4.009, P < 0.05). There was no statistically significant difference in the annual number of patients with chemical burns among the last decade (χ(2) = 0.060, P > 0.05). Chemical burns mainly occurred in summer and autumn, and the incidence gradually increased in April, peaked in August, and then gradually decreased. (3) Five hundred and seventy-two cases (93.0%) were injured while working, among these patients 70.8% (405/572) were injured in private enterprises. (4) Acid was the most common injury-causing chemical (299 patients, accounting for 48.6%). (5) The extremities and head were the most involved areas. (6) Among 615 patients with chemical burns, 47 cases (7.6%) were complicated by inhalation injury, 94 cases (15.3%) by ocular burns, 51 cases (8.3%) by combined injury, and 67 cases (10.9%) by poisoning. (7) Most patients did not receive (30.4%, 187/615) or only insufficient (61.1%, 376/615) immediate irrigation after injury in pre-hospital management. (8) Two hundred and twelve patients (34.5%) underwent skin grafting or flap transplantation after early total or tangential excision of eschar within one week post injury. Among all the patients, 599 cases were cured with 11 eyes becoming blind in 8 patients, and sixteen patients died with a mortality rate of 2.6%.
Patients with chemical burns accounted for a high proportion of the burn patients admitted to our unit in the same period, and they were mainly injured while working. Sufficient irrigation and immediate detoxification are key points in the treatment of chemical burns. Early total or tangential excision of eschar of deep wounds could reduce the possibility of poisoning.
探讨化学烧伤急救、早期处理及治疗中的流行病学因素。
筛选2001年1月至2010年12月期间住院的2682例烧伤患者中615例化学烧伤患者的病历，回顾性分析其临床资料，包括性别、年龄、烧伤面积和深度、发生规律、致伤原因、致伤化学物质、创面部位、并发症、院前处理、治疗及预后。采用线性趋势检验对烧伤患者年例数和化学烧伤患者年例数进行统计学分析。
（1）在所有化学烧伤患者中，男性562例（91.4%），女性53例（8.6%）。患者平均年龄为（32±12）岁。烧伤面积为1%至95%，平均烧伤面积为（30±25）%TBSA。Ⅲ度烧伤面积为0至85%，平均面积为（18±24）%TBSA。（2）过去十年烧伤患者年例数呈缓慢上升趋势（χ(2)=4.009，P<0.05）。过去十年化学烧伤患者年例数差异无统计学意义（χ(2)=0.060，P>0.05）。化学烧伤主要发生在夏秋季节，4月发病率逐渐上升，8月达到高峰，随后逐渐下降。（3）572例（93.0%）患者在工作时受伤，其中70.8%（405/572）在民营企业受伤。（4）酸是最常见的致伤化学物质（299例患者，占48.6%）。（5）四肢和头部是最常受累部位。（6）615例化学烧伤患者中，47例（7.6%）并发吸入性损伤，94例（15.3%）并发眼烧伤，51例（8.3%）并发复合伤，67例（10.9%）并发中毒。（7）在院前处理中，大多数患者受伤后未接受（30.4%，187/615）或仅接受了不足的（61.1%，376/615）即刻冲洗。（8）212例（34.5%）患者在伤后1周内早期行焦痂全切除或削痂术后接受了皮肤移植或皮瓣移植。所有患者中，599例治愈，8例患者11只眼睛失明，16例患者死亡，死亡率为2.6%。
化学烧伤患者在同期我院收治的烧伤患者中占较高比例，且主要在工作时受伤。充分冲洗和即刻解毒是化学烧伤治疗的关键。深度创面早期行焦痂全切除或削痂术可降低中毒可能性。
