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电烧伤患者死亡和住院时间延长的危险因素。

Risk Factors for Mortality and Prolonged Hospitalization in Electric Burn Injuries.

机构信息

Department of Plastic Surgery and Handsurgery, Burn Center, UniversitätsSpital Zürich, Switzerland.

Department of Plastic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt, Germany.

出版信息

J Burn Care Res. 2021 May 7;42(3):505-512. doi: 10.1093/jbcr/iraa192.

DOI:10.1093/jbcr/iraa192
PMID:33137191
Abstract

Electrical injuries are rare, but very destructive with high morbidity and mortality, prolonged hospital length of stay and need for repeated procedures. The aim of study was to investigate characteristics and management of electrical injuries and predisposing factors for mortality and prolonged length of stay. Patient charts were reviewed retrospectively to identify patients admitted with electrical injuries at the Zurich Burns Center (2005-2019). Patient characteristics, management, and outcome were analyzed and risk factors for mortality and prolonged hospitalization were assessed. Eighty-nine patients were included, mostly males (86.5%), between 21 and 40 years (50.6%), with high-voltage (74.2%) occupational injuries (66.3%). Median intensive care unit and hospital stays were 6 (first and third IQR: 2.0; 30.0) and 18 (9.0; 48.0) days. Low-voltage patients had a median of 2 (1.5; 3.0) procedures, compared to 4 (2.0; 10.8) in high-voltage. The amputation rate was 13.5%, and a total of 46 flaps were required. Fifty-four patients had at least one serious complication. Mortality was 18% in high-voltage patients, mostly after multiple organ failure (35%). High total body surface area (TBSA), renal failure and cardiovascular complications were risk factors for mortality (P < .001) in multivariate regression models. Determinants for prolonged hospital stay were TBSA and sepsis (P < .01), and additionally abdominal complications and limb loss for intensive care unit stay (P < .05). Electrical injuries are still cause of significant morbidity and mortality, mostly involve young men in their earning period. Several risk factors for in-hospital mortality and prolonged stay were identified and can support physicians in the management and decision making in these patients.

摘要

电烧伤较为罕见,但具有很高的发病率和死亡率、较长的住院时间和需要多次手术等特点,破坏性极大。本研究旨在探讨电烧伤的特点和处理方法以及导致死亡率和住院时间延长的相关因素。回顾性分析了在苏黎世烧伤中心(2005-2019 年)收治的电烧伤患者的病历。分析了患者的特征、处理方法和结果,并评估了死亡率和住院时间延长的危险因素。共纳入 89 例患者,主要为男性(86.5%),年龄在 21-40 岁(50.6%),主要为职业性高电压(74.2%)损伤(66.3%)。入住重症监护病房和住院的中位数时间分别为 6 天(第 1 和第 3 个四分位数:2.0;30.0)和 18 天(9.0;48.0)。低电压患者的中位数手术次数为 2 次(1.5;3.0),而高电压患者为 4 次(2.0;10.8)。截肢率为 13.5%,共需 46 个皮瓣。54 例患者至少发生了一次严重并发症。高电压患者的死亡率为 18%,主要是由于多器官衰竭(35%)。多变量回归模型显示,总体表烧伤面积(TBSA)较大、肾衰竭和心血管并发症是死亡率的危险因素(P<.001)。住院时间延长的决定因素是 TBSA 和败血症(P<.01),此外还有腹部并发症和四肢丧失导致入住重症监护病房时间延长(P<.05)。电烧伤仍然是导致发病率和死亡率较高的原因,主要发生在处于劳动年龄段的年轻男性。确定了导致住院时间延长和死亡率的几个危险因素,这可以为医生在处理和决策这些患者时提供支持。

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