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[2133例住院电烧伤患者的流行病学调查]

[Epidemiological investigation on 2 133 hospitalized patients with electrical burns].

作者信息

Jiang M J, Li Z, Xie W G

机构信息

Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.

出版信息

Zhonghua Shao Shang Za Zhi. 2017 Dec 20;33(12):732-737. doi: 10.3760/cma.j.issn.1009-2587.2017.12.003.

Abstract

To analyze the epidemiological characteristics of the hospitalized patients with electrical burns in Institute of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital (hereinafter referred to as Institute of Burns of Wuhan Third Hospital), so as to provide reference for the prevention and treatment of electrical burns. Medical records of all hospitalized burn patients in Institute of Burns of Wuhan Third Hospital from January 2004 to December 2016 were collected. Genders, ages, social categories, seasons of injury, total burn areas, depths of wounds, electrical voltages of injury, sites of wound, treatment methods, amputation rates, lengths of hospital stay, operation costs, hospitalization costs, and treatment outcomes of the electrical burn patients were collected. Treatment methods, lengths of hospital stay, operation costs, and hospitalization costs of the thermal burn patients were collected and compared with those of the electrical burn patients. Electrical voltages of injury, amputation rates, operation costs, hospitalization costs, and treatment outcomes were compared and analyzed between the electrical contact burn patients and the electrical arc burn patients. Data were processed with Chi-square test and Wilcoxon rank-sum test. During the 13 years, 23 534 burn patients were admitted to Institute of Burns of Wuhan Third Hospital, among whom 2 133 (9.1%) were with electrical burns, without obvious variation in admission number of electrical burn patients every year. There were 1 418 patients (66.5%) with electrical contact burns and 715 patients (33.5%) with electrical arc burns. The ratio of male to female was 11.2∶1.0 among the electrical burn patients with known genders. The proportions of three age groups of more than 20 years old and less than or equal to 30 years old, more than 30 years old and less than or equal to 40 years old, and more than 40 years old and less than or equal to 50 years old were relatively higher, which were 18.3% (391/2 133), 22.1% (471/2 133), and 24.6% (525/2 133), respectively. The first three social category groups in proportions were workers, peasants, and preschool children, which were 57.9% (1 235/2 133), 14.6% (311/2 133), and 6.0% (128/2 133), respectively. Among the electrical burn patients with known seasons of injury, most cases were injured in summer (659 cases, accounting for 34.1%), obviously more than the proportions in autumn (537 cases, accounting for 27.8%), spring (455 cases, accounting for 23.5%), and winter (283 cases, accounting for 14.6%), with (2) values from 8.414 to 149.573, values below 0.01. The group of patients with total burn areas less than 10% total body surface area (TBSA) occupied the highest proportion (1 603 cases, accounting for 75.15%), among whom 229 (10.74%) were with scattered small wounds which were less than 1% TBSA. The percentage of electrical contact burn patients with deep wounds was 79.1% (1 122/1 418), which was obviously higher than 2.5% (18/715) of the electrical arc burn patients ((2)=381.741, <0.001). Among the patients with known electrical voltages of injury, patients injured by high voltage among the electrical contact burn patients accounted for 78.4% (469/598), which was obviously higher than 8.7% (11/127) of the electrical arc burn patients ((2)=227.893, <0.001). The most common wound site of the electrical burn patients was upper limbs (1 650 cases, accounting for 63.2%), followed by lower limbs (382 cases, accounting for 14.6%), head and neck (292 cases, accounting for 11.2%), trunk (247 cases, accounting for 9.5%), and hip and perineum (40 cases, accounting for 1.5%). The operation rate of electrical burn patients was 32.4% (691/2 133), obviously higher than 19.1% (3 860/20 209)of the thermal burn patients during the same period ((2)=210.255, <0.001). Wounds of 116 electrical contact burn patients were repaired with free flap by vascular anastomosis, of which 9 (7.8%) failed. The length of hospital stay, the operation cost, and the hospitalization cost of electrical burn patients were (28±29) d, (9 534±16 935) and (44 258±93 012) Yuan, respectively, obviously longer or higher than those of the thermal burn patients during the same period [(17±19) d, (2 990±8 916) and (23 291±88 340) Yuan, respectively, with values from -21.323 to -10.996, values below 0.001]. The amputation rate and the death rate of electrical burn patients were 3.8% (82/2 133) and 0.8% (16/2 133) respectively. Compared with those of electrical arc burn patients, the amputation rate and the operation cost of electrical contact burn patients were obviously higher ((2)=36.970, =-11.351, values below 0.001), and the length of hospital stay of electrical contact burn patients was obviously longer (=-5.181, <0.001). There were no significant differences in hospitalization cost and treatment outcome between the electrical contact burn patients and the electrical arc burn patients (=-1.461, (2)=1.673, values above 0.05). The number and the proportion of hospitalized electrical burn patients in Institute of Burns of Wuhan Third Hospital were relatively high, indicating a hard task of prevention for electrical burns in Wuhan area. Working-age workers and farmers, and preschool children were the key groups in prevention from electrical burns. The length of hospital stay, the operation cost, and the hospitalization cost of electrical burn patients were obviously higher than those of thermal burn patients. The amputation rate and the operation cost of electrical contact burn patients were obviously higher than those of electrical arc burn patients, but there were no obvious differences in hospitalization cost or treatment outcome between them. Actively using tissue flaps including free flap to repair of wounds may be helpful to reduce the amputation rate, improve the results, and shorten the time of treatment.

摘要

分析武汉大学同仁医院暨武汉市第三医院烧伤研究所(以下简称武汉市第三医院烧伤研究所)住院电烧伤患者的流行病学特征,为电烧伤的防治提供参考。收集武汉市第三医院烧伤研究所2004年1月至2016年12月期间所有住院烧伤患者的病历。收集电烧伤患者的性别、年龄、社会类别、受伤季节、烧伤总面积、伤口深度、受伤电压、伤口部位、治疗方法、截肢率、住院时间、手术费用、住院费用及治疗结果。收集热烧伤患者的治疗方法、住院时间、手术费用及住院费用,并与电烧伤患者进行比较。比较分析电接触烧伤患者与电弧烧伤患者的受伤电压、截肢率、手术费用、住院费用及治疗结果。数据采用卡方检验和Wilcoxon秩和检验进行处理。13年间,武汉市第三医院烧伤研究所共收治烧伤患者23534例,其中电烧伤患者2133例(9.1%),每年电烧伤患者的收治数量无明显变化。电接触烧伤患者1418例(66.5%),电弧烧伤患者715例(33.5%)。已知性别的电烧伤患者中,男女比例为11.2∶1.0。20岁以上且小于等于30岁、30岁以上且小于等于40岁、40岁以上且小于等于50岁这三个年龄组的比例相对较高,分别为18.3%(391/2133)、22.1%(471/2133)和24.6%(525/2133)。按比例排列,社会类别前三组为工人、农民和学龄前儿童,分别为57.9%(1235/2133)、14.6%(311/2133)和6.0%(128/2133)。在已知受伤季节的电烧伤患者中,大多数病例在夏季受伤(659例,占34.1%),明显高于秋季(537例,占27.8%)、春季(455例,占23.5%)和冬季(283例,占14.6%),χ²值为8.414~149.573,P值均小于0.01。烧伤总面积小于10%总体表面积(TBSA)的患者组占比最高(1603例,占75.15%),其中229例(10.74%)为散在小伤口,小于1%TBSA。电接触烧伤患者中深度伤口的比例为79.1%(1122/1418),明显高于电弧烧伤患者的2.5%(18/715)(χ²=381.741,P<0.001)。在已知受伤电压的患者中,电接触烧伤患者中高压受伤的患者占78.4%(469/598),明显高于电弧烧伤患者的8.7%(11/127)(χ²=227.893,P<0.001)。电烧伤患者最常见的伤口部位是上肢(1650例,占63.2%),其次是下肢(382例,占14.6%)、头颈部(292例,占11.2%)、躯干(247例,占9.5%)和臀部与会阴(40例,占1.5%)。电烧伤患者的手术率为32.4%(691/2133),明显高于同期热烧伤患者的19.1%(3860/20209)(χ²=210.255,P<0.001)。116例电接触烧伤患者的伤口采用吻合血管的游离皮瓣修复,其中9例(7.8%)失败。电烧伤患者的住院时间、手术费用和住院费用分别为(28±29)d、(9534±16935)元和(44258±93012)元,明显长于或高于同期热烧伤患者[分别为(17±19)d、(2990±8916)元和(23291±88340)元,Z值为-21.323~-10.996,P值均小于0.001]。电烧伤患者的截肢率和死亡率分别为3.8%(82/2133)和0.8%(16/2133)。与电弧烧伤患者相比,电接触烧伤患者的截肢率和手术费用明显更高(χ²=36.970,Z=-11.351,P值均小于0.001),电接触烧伤患者的住院时间明显更长(Z=-5.181,P<0.001)。电接触烧伤患者与电弧烧伤患者的住院费用和治疗结果无显著差异(Z=-1.461,χ²=1.673,P值均大于0.05)。武汉市第三医院烧伤研究所住院电烧伤患者的数量和比例相对较高,表明武汉地区电烧伤的预防任务艰巨。青壮年工人、农民和学龄前儿童是电烧伤预防的重点人群。电烧伤患者的住院时间、手术费用和住院费用明显高于热烧伤患者。电接触烧伤患者的截肢率和手术费用明显高于电弧烧伤患者,但两者的住院费用或治疗结果无明显差异。积极采用包括游离皮瓣在内的组织皮瓣修复伤口可能有助于降低截肢率、改善治疗效果并缩短治疗时间。

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