危重症老年烧伤患者的急性期反应。
Acute Phase Response in Critically Ill Elderly Burn Patients.
机构信息
Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Sunnybrook Research Institute, Toronto, ON, Canada.
出版信息
Crit Care Med. 2019 Feb;47(2):201-209. doi: 10.1097/CCM.0000000000003516.
OBJECTIVES
Survival of elderly burn patients remains unacceptably poor. The acute phase, defined as the first 96 hours after burn, includes the resuscitation period and influences subsequent outcomes and survival. The aim of this study was to determine if the acute phase response post burn injury is significantly different in elderly patients compared with adult patients and to identify elements contributing to adverse outcomes.
DESIGN
Cohort study.
SETTING
Tertiary burn center.
PATIENTS
Adult (< 65 yr old) and elderly (≥ 65 yr old) patients with an acute burn injury.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
We included all patients with an acute burn injury greater than or equal to 20% total body surface area to our burn center from 2011 to 2016. Clinical and laboratory measures during the acute phase were compared between adult and elderly patients. Outcomes included clinical hemodynamic measurements, organ biomarkers, volume of fluid resuscitation, cardiac agents, and the inflammatory cytokine response in plasma. Data were analyzed using the Student t test, Mann-Whitney U test, and Fisher exact test. A total of 149 patients were included, with 126 adults and 23 elderly. Injury severity was not significantly different among adult and elderly patients. Elderly had significantly lower heart rates (p < 0.05), cardiac index (p < 0.05), mean arterial pressure (p < 0.05), PaO2/FIO2 (p < 0.05), and pH (p < 0.05), along with higher lactate (p < 0.05). Organ biomarkers, particularly creatinine and blood urea nitrogen, showed distinct differences between adults and elderly (p < 0.05). Elderly had significantly lower levels of interleukin-6, monocyte chemotactic protein-1, monocyte chemotactic protein-3, and granulocyte-colony stimulating factor during the acute phase (p < 0.05). Overall mortality was significantly higher in elderly patients (5% vs 52%; p < 0.0001).
CONCLUSIONS
Response to the burn injury during the acute phase response after burn is substantially different between elderly and adult burn patients and is characterized by cardiac depression and hypoinflammation.
目的
老年烧伤患者的存活率仍然很差。急性期定义为烧伤后 96 小时内，包括复苏期，会影响后续的结果和存活。本研究旨在确定老年烧伤患者与成年患者相比，烧伤后急性期反应是否有显著差异，并确定导致不良预后的因素。
设计
队列研究。
地点
三级烧伤中心。
患者
有急性烧伤损伤的成年（<65 岁）和老年（≥65 岁）患者。
干预措施
无。
测量和主要结果
我们将 2011 年至 2016 年期间我院烧伤中心收治的所有烧伤面积大于或等于 20%总体表面积的患者纳入本研究。比较了成年患者和老年患者在急性期的临床和实验室指标。结果包括临床血流动力学测量、器官标志物、液体复苏量、心脏药物和血浆中炎症细胞因子反应。数据采用学生 t 检验、Mann-Whitney U 检验和 Fisher 确切检验进行分析。共纳入 149 例患者，其中成年患者 126 例，老年患者 23 例。成年患者和老年患者的损伤严重程度无显著差异。老年患者的心率显著较低（p<0.05），心指数（p<0.05）、平均动脉压（p<0.05）、PaO2/FIO2（p<0.05）和 pH 值（p<0.05）较低，而乳酸水平较高（p<0.05）。器官标志物，特别是肌酐和血尿素氮，在成年患者和老年患者之间存在明显差异（p<0.05）。老年患者在急性期的白细胞介素-6、单核细胞趋化蛋白-1、单核细胞趋化蛋白-3 和粒细胞集落刺激因子水平显著较低（p<0.05）。老年患者的总死亡率明显较高（5%比 52%；p<0.0001）。
结论
烧伤后急性期反应，老年烧伤患者与成年烧伤患者的反应有显著差异，表现为心脏抑制和低炎症反应。
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