Huang Ying-Zi, Lu Guo-Zhong, Zhao Hong-Sheng, Liu Li-Jun, Jin Jun, Wu Yun-Fu, Wu Jian, Zhao Fu-Li, Liu Ning, Liu Wen-Ming, Liu Long, Zhu Tuan-Jie, Chen Er-Zhen, Gu Qin, Ye Hong-Wei, Xi Xiu-Ming, Du Bin, Yi Yang, Qiu Hai-Bo
Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
Department of Burn, Burn Intensive Care Unit, Wuxi Third People's Hospital, Wuxi, China.
Ann Transl Med. 2020 Sep;8(17):1053. doi: 10.21037/atm-20-288.
The aim of the study was to identify the clinical features and the factors associated with burn induced mortality among young adults after exposure to indoor explosion and fire.
This is an observational study which included burn patients who were admitted to eighteen ICUs after a fire disaster. Epidemiologic and clinical characteristics, as well as therapy were recorded. The primary outcome was 90-day mortality. The mortality-related factors were also analyzed.
There were 167 burn patients enrolled in the study, the median age was 38 years, 62 (37.1%) patients died within 90 days. Seventy-one percent of patients had a burn size ≥90% TBSA, and 73.7% of patients had a full-thickness burn area above 50% TBSA. The survivors had lower Baux scores, and received earlier escharectomy and autologous skin grafts. The 50% mortality rates (LA50s) for burn size and full-thickness burn area were 95.8% and 88.6% TBSA, respectively. The multivariate analysis showed that full-thickness burn area over 50% TBSA and residual burned surface area (RBSA)/TBSA at 28 days were strong predictors of mortality among burn patients (odds ratio 2.55; 95% CI, 1.01 to 6.44, P=0.047; odds ratio 1.07; 95% CI, 1.04 to 1.09, P<0.001). The ROC curve-based cut-off values of RBSA/TBSA at 28 days for predicting 90-day mortality were 62.5%.
Burn size and full-thickness burn area were the main risk factors for poor outcome in patients with extensive burns. Earlier escharectomy and autologous skin grafts may improve outcomes.
本研究旨在确定年轻成年人在遭受室内爆炸和火灾后烧伤所致死亡的临床特征及相关因素。
这是一项观察性研究，纳入了火灾灾难后入住18个重症监护病房的烧伤患者。记录其流行病学和临床特征以及治疗情况。主要结局为90天死亡率。还对与死亡率相关的因素进行了分析。
本研究共纳入167例烧伤患者，中位年龄为38岁，62例（37.1%）患者在90天内死亡。71%的患者烧伤面积≥90%总体表面积（TBSA），73.7%的患者全层烧伤面积超过50%TBSA。幸存者的烧伤综合评分（Baux评分）较低，且接受了更早的焦痂切除和自体皮肤移植。烧伤面积和全层烧伤面积的50%死亡率（半数致死量，LA50）分别为95.8%和88.6%TBSA。多因素分析显示，全层烧伤面积超过50%TBSA以及28天时的残余烧伤表面积（RBSA）/TBSA是烧伤患者死亡率的强预测因素（比值比2.55；95%置信区间，1.01至6.44，P = 0.047；比值比1.07；95%置信区间，1.04至1.09，P < 0.001）。基于ROC曲线预测90天死亡率的28天时RBSA/TBSA的截断值为62.5%。
烧伤面积和全层烧伤面积是大面积烧伤患者预后不良的主要危险因素。更早进行焦痂切除和自体皮肤移植可能改善预后。
