Pompermaier L, Elmasry M, Steinvall I
Department of Hand Surgery, Plastic Surgery and Burns, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Ann Burns Fire Disasters. 2019 Dec 31;32(4):272-277.
In the Western world, self-inflicted burns are often associated with mental health disorders, and the management, particularly the pain treatment, can often be complicated by the psycho-social background of the patients. The aim was to describe a group of patients with self-inflicted burns by analysing their in-hospital mortality and the use of sedation during procedures. All patients with self-inflicted burns admitted to the Linköping Burn Centre during 2000-2017 were included. The control group consisted of adults (≥17 years) with accidental burns, admitted during the same period. Multivariable logistic and linear regression was used for analysis. Three percent of all patients (47/1601) had self-inflicted burns: most of them were men (60%, 28/47), none was younger than 17 years, and flame was the major cause of injury. Self-inflicted burn patients were younger and had larger burns: mean age (SD) was 42 (16) and 49 (20) years, respectively; mean TBSA (SD) was 29% (26) and 14% (17), respectively. The crude rate of procedures done under sedation was higher (mean (SD) 0.37 (0.23) compared with 0.24 (0.25)) as was crude in-hospital mortality (8/47, 17% compared with 72/1018, 7%). Multivariable analyses showed no difference in the use of sedation for procedures or in-hospital mortality after adjustment for TBSA%, full thickness burns, age and sex. Age and TBSA% were associated with in-hospital mortality, whereas the intentionality of the burn was not. TBSA% and female sex were associated with increased use of sedation for wound care procedures, whereas self-inflicted burns were not.
在西方世界，自伤性烧伤常与精神健康障碍相关，并且其治疗，尤其是疼痛治疗，常常会因患者的心理社会背景而变得复杂。目的是通过分析自伤性烧伤患者的院内死亡率以及手术期间镇静剂的使用情况来描述这一群体。纳入了2000年至2017年期间入住林雪平烧伤中心的所有自伤性烧伤患者。对照组由同期入院的成人（≥17岁）意外烧伤患者组成。采用多变量逻辑回归和线性回归进行分析。所有患者中有3%（47/1601）为自伤性烧伤：其中大多数为男性（60%，28/47），年龄均不小于17岁，火焰是主要致伤原因。自伤性烧伤患者更年轻且烧伤面积更大：平均年龄（标准差）分别为42（16）岁和49（20）岁；平均烧伤总面积（标准差）分别为29%（26）和14%（17）。镇静状态下进行手术的粗发生率更高（平均（标准差）0.37（0.23），而对照组为0.24（0.25）），院内粗死亡率也是如此（8/47，17%，而对照组为72/1018，7%）。多变量分析显示，在对烧伤总面积百分比、全层烧伤、年龄和性别进行调整后，手术中镇静剂的使用或院内死亡率没有差异。年龄和烧伤总面积百分比与院内死亡率相关，而烧伤的故意性则无关。烧伤总面积百分比和女性与伤口护理手术中镇静剂使用增加相关，而自伤性烧伤则无关。
