Mozingo D W, Smith A A, McManus W F, Pruitt B A, Mason A D
U.S. Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Texas 78234-6200.
J Trauma. 1988 May;28(5):642-7. doi: 10.1097/00005373-198805000-00014.
In chemical skin injuries, reduction of the time of exposure to the causative agent and recognition of systemic toxicity are necessary to lessen the severity of the insult, reduce morbidity, and maximize survival. During a 17-year period (1969 through 1985), 87 (2.1%) of the 4,212 burned patients admitted to the U.S. Army Institute of Surgical Research sustained chemical burns. Twelve of 87 patients died (13.8%). White phosphorous, the most common causative agent, produced cutaneous injury in 49 patients. Acids (13 patients), alkalies (ten patients), and organic solvents (five patients) were the other common causes of injury. Initial treatment consisted of water lavage. Later wound management was carried out with topical antibiotic therapy and excision and grafting as necessary. Systemic toxicity due to phenol, nitrate, and formate absorption occurred, as did acute tubular necrosis following copper sulfate treatment of white phosphorus burns. Inhalation injury occurred in five patients. A decrease in hospital stay for chemically injured patients was observed. To minimize chemical injury, clothing should be removed promptly and water lavage begun. Systemic toxicity and inhalation injury are rare but often severe and increase mortality.
在化学性皮肤损伤中，减少接触致病因子的时间并识别全身毒性对于减轻损伤的严重程度、降低发病率和提高生存率至关重要。在1969年至1985年的17年期间，美国陆军外科研究所收治的4212例烧伤患者中有87例（2.1%）发生了化学烧伤。87例患者中有12例死亡（13.8%）。最常见的致病因子白磷导致49例患者发生皮肤损伤。酸（13例患者）、碱（10例患者）和有机溶剂（5例患者）是其他常见的致伤原因。初始治疗包括水洗。后期伤口处理采用局部抗生素治疗，并根据需要进行切除和植皮。因苯酚、硝酸盐和甲酸盐吸收导致全身毒性，硫酸铜治疗白磷烧伤后也出现了急性肾小管坏死。5例患者发生吸入性损伤。观察到化学损伤患者的住院时间有所缩短。为尽量减少化学损伤，应迅速脱去衣物并开始水洗。全身毒性和吸入性损伤虽罕见，但往往很严重且会增加死亡率。
