Chiang I-Han, Chen Shyi-Gen, Huang Kun-Lun, Chou Yu-Ching, Dai Niann-Tzyy, Peng Chung-Kan
Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
Hyperbaric Oxygen Therapy Center, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
Burns. 2017 Jun;43(4):852-857. doi: 10.1016/j.burns.2016.10.016. Epub 2016 Dec 27.
Despite major advances in therapeutic strategies for the management of patients with severe burns, significant morbidity and mortality is observed. Hyperbaric oxygen therapy (HBOT) increases the supply of oxygen to burn areas. The aim of this study was to determine whether HBOT is effective in the treatment of major thermal burns.
On June 27, 2015 in New Taipei, Taiwan, a mass casualty disaster occurred as fire erupted over a large crowd, injuring 499 people. Fifty-three victims (20 women and 33 men) were admitted to Tri-Service General Hospital. Thirty-eight patients underwent adjunctive HBOT (HBOT group), and 15 patients received routine burn therapy (control group). Serum procalcitonin (PCT) level, a sepsis biomarker, was measured until it reached normal levels (<0.5μg/L). The records of all patients from June 2015 to March 2016 were analyzed retrospectively. Outcome measures that were compared between the groups included the use of tracheostomy and hemodialysis, total body surface area (TBSA) and the number of skin graft operations, length of hospital stay, infection status, and mortality.
The mean age of the patients was 22.4 years, and the mean TBSA was 43%. All the patients survived and were discharged without requiring limb amputation or being permanently disabled. Patient characteristics did not differ significantly between the groups. PCT levels returned to normal significantly faster (p=0.007) in the HBOT group.
Multidisciplinary burn care combined with adjunctive HBOT improves sepsis control compared with standard treatment without HBOT. Prospective studies are required to define the role of HBOT in extensive burns.
尽管在严重烧伤患者的治疗策略方面取得了重大进展，但仍观察到显著的发病率和死亡率。高压氧疗法（HBOT）可增加烧伤部位的氧气供应。本研究的目的是确定HBOT在治疗大面积热烧伤方面是否有效。
2015年6月27日，在中国台湾新北市，一场大火在一大群人上方爆发，造成499人受伤，发生了大规模伤亡灾难。53名受害者（20名女性和33名男性）被送往三军总医院。38例患者接受了辅助性HBOT（HBOT组），15例患者接受了常规烧伤治疗（对照组）。测量血清降钙素原（PCT）水平（一种脓毒症生物标志物），直至其达到正常水平（<0.5μg/L）。对2015年6月至2016年3月期间所有患者的记录进行回顾性分析。两组之间比较的结果指标包括气管切开术和血液透析的使用情况、全身表面积（TBSA）和皮肤移植手术的次数、住院时间、感染状况和死亡率。
患者的平均年龄为22.4岁，平均TBSA为43%。所有患者均存活并出院，无需截肢或留下永久性残疾。两组患者的特征无显著差异。HBOT组的PCT水平恢复正常的速度明显更快（p=0.007）。
与不使用HBOT的标准治疗相比，多学科烧伤护理联合辅助性HBOT可改善脓毒症控制。需要进行前瞻性研究来确定HBOT在大面积烧伤中的作用。
