Herndon D N, Barrow R E, Rutan R L, Rutan T C, Desai M H, Abston S
Department of Surgery, University of Texas Medical Branch, Shriners Burns Institute, Galveston 77550.
Ann Surg. 1989 May;209(5):547-52; discussion 552-3. doi: 10.1097/00000658-198905000-00006.
Early excision and grafting of small burn wounds is a generally accepted treatment. Early excision of burn injuries greater than 30% total body surface area (TBSA) in adults, however, has not been universally accepted. In this study, 85 patients whose ages ranged from 17 to 55 years with greater than 30% total body surface area (TBSA) burns were randomly assigned to either early excision or topical antimicrobial therapy and skin grafting after spontaneous eschar separation. Mortality from burns without inhalation injury was significantly decreased by early excision from 45% to 9% in patients who were 17 to 30 years of age (p less than 0.025). No differences in mortality could be demonstrated between therapies in adult patients older than 30 years of age or with a concomitant inhalation injury. Children (n = 259) with similar large burns treated by early excision showed a significant increase in mortality with increasing burn size and with concomitant inhalation injury (p less than 0.05). The mean length of hospital stay of survivors was less than one day per per cent of TBSA burn in both children and adults.
小面积烧伤创面的早期切除与植皮是一种普遍接受的治疗方法。然而，成人烧伤面积超过总体表面积（TBSA）30%的早期切除尚未被广泛接受。在本研究中，85例年龄在17至55岁之间、烧伤面积超过总体表面积（TBSA）30%的患者被随机分为早期切除组或局部抗菌治疗组，并在焦痂自然分离后进行植皮。对于无吸入性损伤的烧伤患者，17至30岁的患者早期切除后的死亡率从45%显著降至9%（p<0.025）。在30岁以上的成年患者或伴有吸入性损伤的患者中，两种治疗方法的死亡率无差异。接受早期切除治疗的类似大面积烧伤的儿童（n=259），随着烧伤面积的增加和伴有吸入性损伤，死亡率显著增加（p<0.05）。儿童和成人幸存者的平均住院天数均小于每TBSA烧伤百分比一天。
