Mendez-Romero Denisse, Clark Audra T, Christie Alana, Wolf Steven E
Department of Surgery, Division of Burn, Trauma, and Critical Care, University of Texas Southwestern Medical Center, E05514B, 5323 Harry Hines Blvd, Dallas, TX 75390 USA.
Burns Trauma. 2018 Oct 15;6:30. doi: 10.1186/s41038-018-0131-2. eCollection 2018.
Severe burn is associated with significant changes in body weight due to resuscitation volumes, fluid shifts, a hypermetabolic state, prolonged bed rest, and caloric intake. Our goal was to quantify and describe trends in weight change in patients with burns of all severities under modern treatment conditions and to identify the time points at which these changes occur.
An institutional review board-approved chart review was conducted of acute burn patients treated at an American Burn Association-verified regional burn center from February 2016 to November 2016. Patients were then divided into three groups based on percent of total burn surface area (%TBSA) burn: 1-19%, 20-39%, and ≥ 40%. Weight was expressed as percent change of weight from baseline. Regression analysis was conducted on percent weight changes for each TBSA group.
We identified 197 burn patients with a length of stay (LOS) of ≥ 7 days. Of the study cohort, 149 had TBSA burn of 1-19%, 27 had TBSA burn of 20-39%, and 21 had TBSA burn of ≥ 40%. All groups had a majority of White male, non-Hispanic patients with mean ages between 40 and 42 years. Burn patients with > 20% TBSA burn had a median increase in weight above baseline of approximately 5 to 8% likely due to resuscitation fluids within the first week of hospitalization. Weight loss below baseline often did not exceed 10% and was more pronounced as LOS increased, mostly in patients with > 20% TBSA burn. Whereas patients with 1-19% TBSA burn on average returned to baseline weight at last measurement, patients with 20-39% TBSA and ≥ 40% TBSA burn continued a decline in weight at 4 weeks ( = 0.57 and 0.55, respectively) on the same trajectory.
Burn patients with > 20% TBSA burn had an increase in weight above baseline of up to 8%, likely due to resuscitation fluids within the first week of hospitalization. Weight loss below baseline often did not exceed 10% and was more pronounced as LOS increased, mostly in patients with > 20% TBSA burn. Therefore, our patients on average, lost body weight to a lesser extent than the maximum mean loss of 22% of pre-burn weight reported prior to modern treatment conditions.
由于复苏液体量、体液转移、高代谢状态、长期卧床休息和热量摄入，严重烧伤与体重的显著变化有关。我们的目标是量化并描述在现代治疗条件下所有严重程度烧伤患者体重变化的趋势，并确定这些变化发生的时间点。
对2016年2月至2016年11月在美国烧伤协会认证的地区烧伤中心接受治疗的急性烧伤患者进行了一项经机构审查委员会批准的图表回顾。然后根据烧伤总面积（%TBSA）将患者分为三组：1-19%、20-39%和≥40%。体重以相对于基线体重的变化百分比表示。对每个TBSA组的体重变化百分比进行回归分析。
我们确定了197例住院时间（LOS）≥7天的烧伤患者。在研究队列中，149例患者的TBSA烧伤为1-19%，27例患者的TBSA烧伤为20-39%，21例患者的TBSA烧伤≥40%。所有组中大多数是白人男性、非西班牙裔患者，平均年龄在40至42岁之间。TBSA烧伤>20%的烧伤患者在住院第一周体重较基线中位数增加约5%至8%，可能是由于复苏液体。低于基线的体重减轻通常不超过10%，且随着住院时间延长更为明显，主要发生在TBSA烧伤>20%的患者中。虽然TBSA烧伤为1-19%的患者在最后一次测量时平均恢复到基线体重，但TBSA烧伤为20-39%和≥40%的患者在4周时体重继续下降（分别为=0.57和0.55），呈相同趋势。
TBSA烧伤>20%的烧伤患者体重较基线增加高达8%，可能是由于住院第一周的复苏液体。低于基线的体重减轻通常不超过10%，且随着住院时间延长更为明显，主要发生在TBSA烧伤>20%的患者中。因此，我们的患者平均体重减轻程度低于现代治疗条件之前报道的烧伤前体重最大平均减轻22%的程度。
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