电击伤——双中心患者特征、治疗细节和预后预测因素分析。
Electrical injury - a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors.
机构信息
Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, St. Georg Hospital, Delitzscher Str. 141, 04129, Leipzig, Germany.
Department of Medical Psychology, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany.
出版信息
Scand J Trauma Resusc Emerg Med. 2018 May 31;26(1):43. doi: 10.1186/s13049-018-0513-2.
BACKGROUND
Electrical injuries represent life-threatening emergencies. Evidence on differences between high (HVI) and low voltage injuries (LVI) regarding characteristics at presentation, rhabdomyolysis markers, surgical and intensive burn care and outcomes is scarce.
METHODS
Consecutive patients admitted to two burn centers for electrical injuries over an 18-year period (1998-2015) were evaluated. Analysis included comparisons of HVI vs. LVI regarding demographic data, diagnostic and treatment specific variables, particularly serum creatinine kinase (CK) and myoglobin levels over the course of 4 post injury days (PID), and outcomes.
RESULTS
Of 4075 patients, 162 patients (3.9%) with electrical injury were analyzed. A total of 82 patients (50.6%) were observed with HVI. These patients were younger, had considerably higher morbidity and mortality, and required more extensive burn surgery and more complex burn intensive care than patients with LVI. Admission CK and myoglobin levels correlated significantly with HVI, burn size, ventilator days, surgical interventions, amputation, flap surgery, renal replacement therapy, sepsis, and mortality. The highest serum levels were observed at PID 1 (myoglobin) and PID 2 (CK). In 23 patients (14.2%), cardiac arrhythmias were observed; only 4 of these arrhythmias occurred after hospital admission. The independent predictors of mortality were ventilator days (OR 1.27, 95% CI 1.06-1.51, p = 0.009), number of surgical interventions (OR 0.47, 95% CI 0.27-0.834, p = 0.010) and limb amputations (OR 14.26, 95% CI 1.26-162.1, p = 0.032).
CONCLUSIONS
Patients with electrical injuries, HVI in particular, are at high risk for severe complications. Due to the need for highly specialized surgery and intensive care, treatment should be reserved to burn units. Serum myoglobin and CK levels reflect the severity of injury and may predict a more complex clinical course. Routine cardiac monitoring > 24 h post injury does not seem to be necessary.
背景
电伤是危及生命的紧急情况。关于高电压（HVI）和低电压（LVI）电伤在表现、横纹肌溶解标志物、手术和重症烧伤治疗以及结局方面的差异，证据很少。
方法
对 18 年间（1998-2015 年）连续入住两个烧伤中心的电伤患者进行评估。分析包括比较 HVI 与 LVI 的人口统计学数据、诊断和治疗特定变量，特别是伤后 4 天（PID）内的血清肌酸激酶（CK）和肌红蛋白水平，以及结局。
结果
4075 例患者中，有 162 例（3.9%）电伤患者进行了分析。共有 82 例（50.6%）患者发生 HVI。这些患者年龄更小，发病率和死亡率更高，需要更广泛的烧伤手术和更复杂的烧伤重症监护，而 LVI 患者则不需要。入院时 CK 和肌红蛋白水平与 HVI、烧伤面积、呼吸机天数、手术干预、截肢、皮瓣手术、肾脏替代治疗、脓毒症和死亡率显著相关。最高的血清水平在 PID1（肌红蛋白）和 PID2（CK）观察到。在 23 例（14.2%）患者中观察到心律失常；只有 4 例心律失常发生在住院后。死亡率的独立预测因素是呼吸机天数（OR 1.27，95%CI 1.06-1.51，p=0.009）、手术干预次数（OR 0.47，95%CI 0.27-0.834，p=0.010）和肢体截肢（OR 14.26，95%CI 1.26-162.1，p=0.032）。
结论
电伤患者，特别是 HVI 患者，发生严重并发症的风险很高。由于需要高度专业化的手术和重症监护，治疗应限于烧伤科。血清肌红蛋白和 CK 水平反映了损伤的严重程度，可能预测更复杂的临床病程。伤后 24 小时以上常规进行心脏监测似乎没有必要。
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