You Kicheol, Yang Hyeong-Tae, Kym Dohern, Yoon Jaechul, Cho Yong-Suk, Hur Jun, Chun Wook, Kim Jong-Hyun
Department of Emergency Medicine, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, 12, Beodeunaru-ro 7-gil (Youngdeungpo-dong 2-ga), Youngdeungpo-gu, Seoul 150-719, Republic of Korea.
Department of Surgery, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, 12, Beodeunaru-ro 7-gil (Youngdeungpo-dong 2-ga), Youngdeungpo-gu, Seoul 150-719, Republic of Korea; Department of Surgery, Kangwon National University College of Medicine, Kangwondaehak 1 gil, Chuncheon-si, Gangwon-do 200-701, Republic of Korea.
Burns. 2014 Dec;40(8):1470-5. doi: 10.1016/j.burns.2014.09.015. Epub 2014 Oct 16.
This study was to re-evaluate inhalation injury as a prognostic factor in burn patients and to determine the factors that should be considered when refining the definition of inhalation injury. A total of 192 burn patients (152 men, 40 women; mean age, 46.1±13.8 years) who were suspected to have an inhalation injury and underwent bronchoscopy between January 2010 and June 2012 were included in this prospective observational study. All patients underwent bronchoscopy within 24h of sustaining the burn. The bronchoscopic findings were classified as normal, mild, moderate, and severe. Mechanical ventilation was administered, when required. Age, percentage of TBSA burned, ABSI score, requirement of mechanical ventilation and PF ratio, but not inhalation injury, COHb level, and bronchoscopic grades, significantly differed between the survivors and non-survivors (p<0.05). Mechanical ventilation (adjusted odds ratio [OR]: 9.787) and severe inhalation injury on bronchoscopy (adjusted OR: 45.357) were independent predictors of mortality on multivariate logistic regression analysis. Inhalation injury diagnosed through history does not predict mortality from burns. Other components such as severity of inhalation injury determined using bronchoscopy, and administration of mechanical ventilation might help predict the morbidity and mortality of burn patients with inhalation injury and all of the factors should be considered when the definition of inhalation injury is refined.
本研究旨在重新评估吸入性损伤作为烧伤患者预后因素的情况，并确定在完善吸入性损伤定义时应考虑的因素。本前瞻性观察性研究纳入了2010年1月至2012年6月期间疑似有吸入性损伤且接受支气管镜检查的192例烧伤患者（152例男性，40例女性；平均年龄46.1±13.8岁）。所有患者在烧伤后24小时内接受支气管镜检查。支气管镜检查结果分为正常、轻度、中度和重度。必要时进行机械通气。幸存者和非幸存者在年龄、烧伤总面积百分比、ABSI评分、机械通气需求和PF比值方面存在显著差异，但吸入性损伤、碳氧血红蛋白水平和支气管镜分级无显著差异（p<0.05）。多因素逻辑回归分析显示，机械通气（调整后的优势比[OR]：9.787）和支气管镜检查显示的重度吸入性损伤（调整后的OR：45.357）是死亡的独立预测因素。通过病史诊断的吸入性损伤不能预测烧伤死亡率。其他因素，如使用支气管镜确定的吸入性损伤严重程度以及机械通气的应用，可能有助于预测吸入性损伤烧伤患者的发病率和死亡率，在完善吸入性损伤定义时应考虑所有这些因素。
