Hu Han-Chung, Chang Chih-Hao, Hsu Hsiang-Hao, Chang Chia-Ming, Huang Chung-Chi, Chuang Shiow-Shuh, Kao Kuo-Chin
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Respiratory Therapy, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Burns. 2018 Feb;44(1):134-139. doi: 10.1016/j.burns.2017.06.011. Epub 2017 Jul 24.
Around 10%-20% of burned patients have inhalation injuries, and the severity of these injuries is correlated with mortality. Fiberoptic bronchoscopy is an important tool for the early diagnosis of inhalation injury. This study investigated correlations between the severity of inhalation injury and outcomes of patients involved in a cornstarch dust explosion in northern Taiwan in 2015.
Patients with burns who were intubated after the explosion were enrolled. Their medical records were reviewed, and data including patient characteristics, percentage of total body surface area (%TBSA) burned, severity of the inhalation injury, mechanical ventilation settings, and outcomes were collected and analyzed.
Twenty patients underwent fiberoptic bronchoscopy during the first 24h to evaluate an inhalation injury. Their mean age was 22.4±5.5 years and the mean %TBSA burned was 55.7±19.4%. Fourteen patients had a grade 1 inhalation injury and six had a grade 2 injury. There was a higher %TBSA burned in the grade 1 group than in the grade 2 group, although the difference did not reach statistical significance (60.0±20.3% versus 45.5±13.5%, p=0.129). Compared to the grade 2 group, the grade 1 group had a significantly higher white blood cell count (29.4±9.3 versus 18.6±4.6, p=0.015) and frequency of facial burns (85.7% versus 33.3%, p=0.037). The overall intensive care unit mortality rate was 10% (n=2), with no significant intergroup difference (grade 1, 14.3% versus grade 2, 0%, p=0.192).
Although the explosion resulted in a high rate of inhalation injuries in critically ill patients, there was no significant correlation between mortality and the severity of the inhalation injuries.
约10%-20%的烧伤患者存在吸入性损伤，且这些损伤的严重程度与死亡率相关。纤维支气管镜检查是早期诊断吸入性损伤的重要工具。本研究调查了2015年台湾北部一起玉米淀粉粉尘爆炸事件中患者吸入性损伤的严重程度与预后之间的相关性。
纳入爆炸后插管的烧伤患者。回顾他们的病历，收集并分析包括患者特征、烧伤总面积百分比（%TBSA）、吸入性损伤严重程度、机械通气设置及预后等数据。
20例患者在伤后24小时内接受了纤维支气管镜检查以评估吸入性损伤。他们的平均年龄为22.4±5.5岁，平均烧伤总面积百分比为55.7±19.4%。14例患者为1级吸入性损伤，6例为2级损伤。1级组的烧伤总面积百分比高于2级组，尽管差异未达到统计学意义（60.0±20.3%对45.5±13.5%，p=0.129）。与2级组相比，1级组的白细胞计数显著更高（29.4±9.3对18.6±4.6，p=0.015），面部烧伤发生率也更高（85.7%对33.3%，p=0.037）。重症监护病房的总体死亡率为10%（n=2），组间无显著差异（1级，14.3%对2级，0%，p=0.192）。
尽管爆炸导致重症患者吸入性损伤发生率较高，但死亡率与吸入性损伤的严重程度之间无显著相关性。
