Qin F J, Chen Z, Zhao Y H, Yu D J, Tang B, Xu G, Zhou N, Liu L J, Shen Y M
Department of Burns, Beijing Jishuitan Hospital, Beijing 100035, China.
Zhonghua Shao Shang Za Zhi. 2018 Jun 20;34(6):349-353. doi: 10.3760/cma.j.issn.1009-2587.2018.06.007.
To analyze effects of cooperation between physicians in department of burn surgery and department of intensive care medicine on rescue and treatment of severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident. On August 2nd, 2014, 15 extremely severe burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident were admitted to temporary burn treatment center established in Department of Critical Care Medicine of the Second Affiliated Hospital of Soochow University. The 15 patients were equally divided into 3 groups, with 5 patients in each group. Fifteen surgeons and 30 nurses from department of burn surgery and 15 physicians and 30 nurses from department of intensive care medicine from different hospitals in China were divided into 3 groups, with 5 physicians and 10 nurses from department of burn surgery and 5 physicians and 10 nurses from department of intensive care medicine in each group. Each group of physicians and nurses were responsible for treatment of 5 patients. Treatment of patients was leaded by surgeons from department of burn surgery, who were responsible for wound dealing and operation. Physicians from department of intensive care medicine were responsible for systemic treatment and adjustment of relevant equipment's parameters. Volume of fluid infusion and urine output in shock period, severe systemic complication during period of treatment, using time and kind of antibiotics, death in 1 month after admission, length of hospital stay, and survival of patients were monitored. Volume of fluid infusion of 15 extremely severe burn patients within the first 24 hours post injury was 10 360-17 162 (12 998±1 811) mL, including (1.62±0.23) mL·% total body surface area (TBSA)(-1)·kg(-1) electrolyte and colloid and (2 850±232) mL glucose, with electrolyte and colloid ratio of (1.76±0.23)∶1.00. Volume of urine output within the first 24 hours post injury was (2 384±1 242) mL, with (99±52) mL in each hour. Volume of fluid infusion of 15 extremely severe burn patients within the second 24 hours post injury was 8 720-11 616 (9 406±1 277) mL, including (1.04±0.22) mL·%TBSA(-1)·kg(-1) electrolyte and colloid and (2 910±187) mL glucose, with electrolyte and colloid ratio of (1.53±0.31)∶1.00. Volume of urine output within the second 24 hours post injury of patients was (2 299±1 362) mL , with (108±61) mL in each hour. One patient had pulmonary infection, and 7 patients had fungal infection, and no patient had gut microbiota dysbiosis. Patients were treated with combined 2 kinds of antibiotics for 21-85 (50±16) d. No patient died within 1 month after admission. The length of hospital stay was 53-132 (98±44) d. Ten patients survived finally. After being treated by cooperation between physicians in department of burn surgery and department of intensive care medicine, severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident had hemodynamic stability and could stably experience shock period, with less complication, shorter length of hospital stay, no death within 1 month after admission, more survived patients, which can provide reference for rescue and treatment of severe mass burn patients.
分析烧伤外科与重症医学科合作对昆山工厂8·2铝粉尘爆炸事故中重度群体性烧伤患者救治的影响。2014年8月2日，将昆山工厂8·2铝粉尘爆炸事故中的15例特重度烧伤患者收治于苏州大学附属第二医院重症医学科设立的临时烧伤救治中心。15例患者平均分为3组，每组5例。将来自国内不同医院的烧伤外科15名医生和30名护士、重症医学科15名医生和30名护士分为3组，每组包括烧伤外科5名医生和10名护士、重症医学科5名医生和10名护士。每组医护人员负责5例患者的治疗。患者治疗由烧伤外科医生牵头，负责创面处理及手术。重症医学科医生负责全身治疗及相关设备参数调整。监测休克期液体入量及尿量、治疗期间严重全身并发症、抗生素使用时间及种类、入院后1个月内死亡情况、住院时间及患者存活情况。15例特重度烧伤患者伤后第1个24小时液体入量为10 360～17 162（12 998±1 811）mL，其中电解质和胶体为（1.62±0.23）mL·%体表面积（TBSA）（-1）·kg（-1），葡萄糖为（2 850±232）mL，电解质与胶体比例为（1.76±0.23）∶1.00。伤后第1个24小时尿量为（2 384±1 242）mL，每小时（99±52）mL。15例特重度烧伤患者伤后第2个24小时液体入量为8 720～11 616（9 406±1 277）mL，其中电解质和胶体为（1.04±0.22）mL·%TBSA（-1）·kg（-1），葡萄糖为（2 910±187）mL，电解质与胶体比例为（1.53±0.31）∶1.00。患者伤后第2个24小时尿量为（2 299±1 362）mL，每小时（108±61）mL。1例患者发生肺部感染，7例患者发生真菌感染，无患者发生肠道菌群失调。患者联合应用2种抗生素治疗21～85（50±16）d。入院后1个月内无患者死亡。住院时间为53～132（98±44）d。最终10例患者存活。经烧伤外科与重症医学科医生合作治疗后，昆山工厂8·2铝粉尘爆炸事故中重度群体性烧伤患者血流动力学稳定，能平稳度过休克期，并发症少，住院时间缩短，入院后1个月内无死亡，存活患者增多，可为重度群体性烧伤患者的救治提供参考。
