Nitzschke Stephanie L, Aden James K, Serio-Melvin Maria L, Shingleton Sarah K, Chung Kevin K, Waters J A, King Booker T, Burns Christopher J, Lundy Jonathan B, Salinas José, Wolf Steven E, Cancio Leopoldo C
From the *U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas; †Uniformed Services University for the Health Sciences, Bethesda, Maryland; ‡Naval Medical Research Unit-San Antonio, Fort Sam Houston, Texas; §University of Texas Health Science Center at San Antonio.
J Burn Care Res. 2014 Nov-Dec;35(6):474-9. doi: 10.1097/BCR.0000000000000039.
The rate of wound healing and its effect on mortality has not been well described. The objective of this article is to report wound healing trajectories in burn patients and analyze their effects on in-hospital mortality. The authors used software (WoundFlow) to depict burn wounds, surgical results, and healing progression at multiple time points throughout admission. Data for all patients admitted to the intensive care unit with ≥ 20% TBSA burned were collected retrospectively. The open wound size (OWS), which includes both unhealed burns and unhealed donor sites, was measured. We calculated the rate of wound closure (healing rate), which we defined as the change in OWS/time. We also determined the time delay (DAYS) from day of burn until day on which there was a reduction in OWS < 10%. Data are medians [interquartile range]. There were 38 patients with complete data; 25 had documentation of successful healing (H), and 13 did not (NH). H differed from NH on age (38 years [32-57] vs 63 [51-74]), body mass index (27 [21-28] vs 32 [19-52]), 24-hour fluid resuscitation (12 L [10-16] vs 18 [15-20]), pressors during first 48 hours (72% vs 100%), use of renal replacement therapy (32% vs 92%), and mortality (4% vs 100%). Repeated measures analysis of covariance showed a significant difference between survivors and nonsurvivors on OWS as a function of time (P<.001). Patients with a positive healing rate (+2%/day) after postburn day 20 had 100% survival whereas those with a negative healing rate (-2%/day) had 100% mortality. For H patients, median DAYS was 41 (28-54); median DAYS/TBSA was 1.3 (1.0-1.9). Survivors had a 0.62% drop in OWS/day, or 4.3%/week. In this cohort of patients with ≥ 20% TBSA, there was a difference in mortality after postburn day 20, between patients with a positive healing rate (+2%/day, 100% survival) and those with a negative healing rate (-2%/day, 100% mortality, P < .05).
伤口愈合速度及其对死亡率的影响尚未得到充分描述。本文的目的是报告烧伤患者的伤口愈合轨迹，并分析其对住院死亡率的影响。作者使用软件（WoundFlow）描绘烧伤创面、手术结果以及整个住院期间多个时间点的愈合进展。回顾性收集了所有入住重症监护病房且烧伤总面积≥20%的患者的数据。测量了开放性伤口大小（OWS），包括未愈合的烧伤创面和未愈合的供皮区。我们计算了伤口闭合率（愈合率），定义为OWS的变化/时间。我们还确定了从烧伤日到OWS减少<10%之日的时间延迟（天数）。数据为中位数[四分位间距]。有38例患者数据完整；25例有成功愈合（H）的记录，13例没有（NH）。H组与NH组在年龄（38岁[32 - 57]对63岁[51 - 74]）、体重指数（27[21 - 28]对32[19 - 52]）、24小时液体复苏量（12升[10 - 16]对18升[15 - 20]）、最初48小时使用升压药情况（72%对100%）、使用肾脏替代治疗情况（32%对92%）以及死亡率（4%对100%）方面存在差异。重复测量协方差分析显示，幸存者和非幸存者在OWS随时间变化方面存在显著差异（P<.001）。烧伤后第20天愈合率为正（+2%/天）的患者生存率为100%，而愈合率为负（-2%/天）的患者死亡率为100%。对于H组患者，中位数天数为41天（28 - 54天）；中位数天数/烧伤总面积为1.3（1.0 - 1.9）。幸存者的OWS每天下降0.62%，即每周下降4.3%。在这个烧伤总面积≥20%的患者队列中，烧伤后第20天，愈合率为正（+2%/天，生存率100%）和愈合率为负（-2%/天，死亡率100%）的患者在死亡率方面存在差异（P <.05）。
