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[2008年至2016年某单中心烧伤面积小于30%总体表面积的吸入性损伤患者的流行病学特征及预后分析]

[Epidemiological characteristics and outcome analysis of inhalation injury patients combined with burn area less than 30% total body surface area in a single center from 2008 to 2016].

作者信息

Jiang Y, Wang Z F, Wang Baoli, Hu Lunyang, Zhu Banghui, Wu Guosheng, Sun Yu, Xia Zhaofan

机构信息

Burn Institute of PLA, Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Research Unit of Key Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai 200433, China.

出版信息

Zhonghua Shao Shang Za Zhi. 2021 Mar 24;37:1-10. doi: 10.3760/cma.j.cn501120-20200229-00106.

Abstract

To explore the epidemiological characteristics and treatment outcomes of inhalation injury patients combined with burn area less than 30% total body surface area (TBSA) admitted to the First Affiliated Hospital of Naval Medical University. Retrospective observational study with performed on medical records of 266 inhalation injury patients combined with burn area less than 30% TBSA who were admitted to the First Affiliated Hospital of Naval Medical University from January 2008 to September 2016 and met the inclusion criteria. The gender, age, injured site, injurious factors of inhalation injury, degree of inhalation injury, combined total burn area, way of tracheotomy, time of tracheotomy, whether conducted mechanical ventilation or not, whether in intensive care unit (ICU) or not, microbial culture results of bronchoalveolar lavage, total hospitalization days, ICU days, mechanical ventilation days, and whether respiratory infections occurred or not. Single factor and multivariate linear regression analysis was used to screen out the risk factors impacting the total hospitalization days, ICU days, and mechanical ventilation days of patients. Single factor and multivariate logistic regression analysis was used to screen out the risk factors impacting respiratory infections of patients. The 266 patients included 190 males and 76 females, with the majority age of above and equal to 21 and below 65 years (217 patients). Confined space was the major injured site. Hot air was the major factor of inhalation injury. Mild and moderate inhalation injuries were commonly seen in patients. The combined total burn area was 9.00 (3.25, 18.00) %TBSA. In 111 patients who were conducted with tracheotomy, the most were conducted before admitted to the First Affiliated Hospital of Naval Medical University. The total hospitalization days of patients were 27 (10, 55) days. The ICU days of 160 patients were 15.5 (6.0, 40.0) days. The mechanical ventilation days of 109 patients were 6.0 (1.3, 11.5) days. A total of 119 patients were diagnosed with respiratory infections, with 548 strains including 35 types of pathogens were isolated, mainly of Gram-negative bacteria. Single factor linear regression analysis showed age, injurious factors of inhalation injury, combined total burn area, degree of inhalation injury, way of tracheotomy, whether conducted mechanical ventilation or not, and whether respiratory infections occurred or not were the risk factors impacting the total hospitalization days of patients (95% confidence interval (CI)=-0.397-0.001, -0.395--0.053, 0.015-0.028, 0.009-0.263, 0.008-0.319, -0.419--0.176, 0.242-0.471, 0.340-0.555, <0.1). Multivariate linear regression analysis showed smoke inhalation, mechanical ventilation, and respiratory infections were the independent risk factors impacting the total hospitalization days of patients (95% CI=-0.384-0.082, 0.022-0.271, 0.261-0.506, <0.05 or <0.01). Single factor linear regression analysis showed injurious factors of inhalation injury, combined total burn area, degree of inhalation injury, way of tracheotomy, whether conducted mechanical ventilation or not, and whether respiratory infections occurred or not were the risk factors impacting the ICU days of patients (95% CI=0.053-0.502, 0.006-0.010, -0.018-0.457, -0.022-0.428, -0.575--0.241, -0.687--0.018, 0.132-0.486, 0.369-0.678, <0.1). Multivariate linear regression analysis showed that no tracheotomy and respiratory infections were the independent risk factors impacting the ICU days of patients (95% CI=-0.414--0.084, 0.278-0.601, <0.01). Single factor linear regression analysis showed injured site, injurious factors of inhalation injury, combined total burn area, degree of inhalation injury, way of tracheotomy, and whether respiratory infections occurred or not were the risk factors impacting mechanical ventilation days of patients (95% CI=-0.565--0.034, 0.145-0.946, 0.051-1.188, 0.001-0.009, 0.127-0.847, 0.436-1.162, -1.243--0.229, 0.005-0.605, <0.1). Multivariate linear regression analysis showed open space inhalation, smoke inhalation, severe inhalation injury, no tracheotomy, prophylactic tracheotomy, and respiratory infections were the independent risk factors impacting mechanical ventilation days of patients (95% CI=-0.588--0.127, 0.138-0.560, 0.143-0.848, -0.909--0.330, -1.008--0.015, 0.007-0.519, <0.05 or <0.01). Single factor logistic regression analysis showed age, injured site, degree of inhalation injury, combined total burn area, way of tracheotomy, and whether conducted mechanical ventilation or not were the risk factors impacting respiratory infections of patients (95% CI=0.840-1.362, 0.641-1.044, 1.122-1.526, 1.028-1.661, 1.344-2.405, 1.460-2.612, 0.744-1.320, 0.241-0.424, 2.331-4.090, <0.1). Multivariate logistic regression analysis showed prophylactic tracheotomy, no tracheotomy, and mechanical ventilation were the independent risk factors impacting respiratory infections of patient (95% CI=0.430-0.641, 0.290-0.511, 2.152-8.624, <0.05 or <0.01). The inhalation injury patients combined with burn area less than 30% TBSA are mainly young and middle-aged males. Confined space, smoke inhalation, mechanical ventilation, respiratory infection, and way of tracheotomy are influencing factors of the outcomes in hospital of inhalation injury patients combined with burn area less than 30% TBSA. Additionally, prophylactic tracheotomy shows its potential role in avoiding respiratory infection for patients with moderate or severe degree of inhalation injury.

摘要

为探讨海军军医大学第一附属医院收治的烧伤面积小于30%总体表面积(TBSA)的吸入性损伤患者的流行病学特征及治疗效果。对2008年1月至2016年9月收治于海军军医大学第一附属医院且符合纳入标准的266例烧伤面积小于30%TBSA的吸入性损伤患者的病历进行回顾性观察研究。记录患者的性别、年龄、受伤部位、吸入性损伤的致伤因素、吸入性损伤程度、合并烧伤总面积、气管切开方式、气管切开时间、是否进行机械通气、是否入住重症监护病房(ICU)、支气管肺泡灌洗微生物培养结果、总住院天数、ICU住院天数、机械通气天数以及是否发生肺部感染。采用单因素和多因素线性回归分析筛选出影响患者总住院天数、ICU住院天数和机械通气天数的危险因素。采用单因素和多因素logistic回归分析筛选出影响患者肺部感染的危险因素。266例患者中男性190例,女性76例,以21岁及以上且65岁及以下年龄段为主(217例)。密闭空间是主要受伤部位。热空气是吸入性损伤的主要因素。患者以轻度和中度吸入性损伤为主。合并烧伤总面积为9.00(3.25,18.00)%TBSA。111例行气管切开的患者中,多数在入住海军军医大学第一附属医院前已行气管切开。患者总住院天数为27(10,55)天。160例患者的ICU住院天数为15.5(6.0,40.0)天。109例患者的机械通气天数为6.0(1.3,11.5)天。共119例患者被诊断为肺部感染,分离出包括35种病原体的548株菌株,以革兰阴性菌为主。单因素线性回归分析显示年龄、吸入性损伤致伤因素、合并烧伤总面积、吸入性损伤程度、气管切开方式、是否进行机械通气以及是否发生肺部感染是影响患者总住院天数的危险因素(95%置信区间(CI)=-0.397-0.001,-0.395--0.053,0.015-0.028,0.009-0.263,0.008-0.319,-0.419--0.176,0.242-0.471,0.340-0.555,<0.1)。多因素线性回归分析显示烟雾吸入、机械通气和肺部感染是影响患者总住院天数的独立危险因素(95%CI=-0.384-0.082,0.022-0.271,0.261-0.506,<0.05或<0.01)。单因素线性回归分析显示吸入性损伤致伤因素、合并烧伤总面积、吸入性损伤程度、气管切开方式、是否进行机械通气以及是否发生肺部感染是影响患者ICU住院天数的危险因素(95%CI=0.053-0.502,0.006-0.010,-0.018-0.457,-0.022-0.428,-0.575--0.241,-0.687--0.018,0.132-0.486,0.369-0.678,<0.1)。多因素线性回归分析显示未行气管切开和肺部感染是影响患者ICU住院天数的独立危险因素(95%CI=-0.414--0.084,0.278-0.601,<0.01)。单因素线性回归分析显示受伤部位、吸入性损伤致伤因素、合并烧伤总面积、吸入性损伤程度、气管切开方式以及是否发生肺部感染是影响患者机械通气天数的危险因素(95%CI=-0.565--0.034,0.145-0.946,0.051-1.188,0.001-0.009,0.127--0.847,0.436-1.162,-1.243--0.229,0.005-0.605,<0.1)。多因素线性回归分析显示开放空间吸入、烟雾吸入、重度吸入性损伤、未行气管切开、预防性气管切开和肺部感染是影响患者机械通气天数的独立危险因素(95%CI=-0.588--0.127,0.138-0.5

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