Zhou J X, Guo G H, Yu G, Hong H L, Xie W G, Liu S H
Department of Burns, Tongren Hospital of Wuhan University＆Wuhan Third Hospital, Wuhan 430060, China.
Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China.
Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2022 May 20;38(5):415-421. doi: 10.3760/cma.j.cn501225-20220214-00027.
To summarize the clinical outcomes of burn patients in different stages of pregnancy and explore a rational therapeutic scheme for burns during pregnancy. A retrospective observational study was conducted. From June 2010 to June 2020, 21 patients who met the inclusion criteria were admitted to the Department of Burns of Wuhan Third Hospital and 14 patients who met the inclusion criteria were admitted to the Department of Burns of the First Affiliated Hospital of Nanchang University. Based on the pregnancy period when patients suffered burns, the 35 patients were divided into early pregnancy group with 18 patients (aged (26±4) years, with 8 (4, 11) weeks of gestation), middle pregnancy group with 10 patients (aged (26±3) years, with 21 (14, 27) weeks of gestation), and late pregnancy group with 7 patients (aged (30±5) years, with 32 (29, 35) weeks of gestation). All the patients received treatment including fluid resuscitation, anti-infection, wound treatment, and multidisciplinary comprehensive managements. The burn-related complications during the treatment, maternal outcomes, fetal outcomes, fetal delivery mode, gestational weeks at delivery, and newborn weight of patients in the 3 groups were recorded. Data were statistically analyzed with one-way analysis of variance, Kruskal-Wallis test, and Fisher's exact probability test. During the treatment, there were 4, 4, and 2 patients who suffered wound infections and 1, 3, and 2 patients who developed shock symptoms, respectively, in early pregnancy group, middle pregnancy group, and late pregnancy group. There were no statistically significant differences in them among the 3 groups (>0.05). One patient in late pregnancy group developed into multiple organ dysfunction syndrome after debridement. At last, all the pregnant women survived, and no statistically significant difference existed among the 3 groups (>0.05). In early pregnancy group, middle pregnancy group, and late pregnancy group, the survived fetus cases were 9, 8, and 6, respectively, and the differences between them were not statistically significant (>0.05). Variables including stillbirth and full-term birth were close in patients in the 3 groups (>0.05), while the preterm birth and miscarriage in patients in the 3 groups were statistically different (<0.05 or <0.01), with the early pregnancy group having the most miscarriage cases and the fewest preterm birth cases. There were no statistically significant differences in fetal delivery mode, gestational weeks at delivery, and newborn weight among the patients with survived fetus in 3 groups (>0.05). For patients suffering burns during early, middle, and late pregnancy, superior rates of maternal and fetal survival can be achieved after timely and adequate treatments including fluid resuscitation, anti-infection, wound treatment, and multidisciplinary comprehensive managements.
总结不同孕期烧伤患者的临床结局，探索孕期烧伤的合理治疗方案。进行一项回顾性观察研究。2010年6月至2020年6月，武汉第三医院烧伤科收治符合纳入标准的患者21例，南昌大学第一附属医院烧伤科收治符合纳入标准的患者14例。根据患者烧伤时的孕周，将35例患者分为早孕组18例（年龄(26±4)岁，孕周8(4,11)周）、中孕组10例（年龄(26±3)岁，孕周21(14,27)周）、晚孕组7例（年龄(30±5)岁，孕周32(29,35)周）。所有患者均接受了液体复苏、抗感染、创面处理及多学科综合管理等治疗。记录3组患者治疗期间的烧伤相关并发症、母体结局、胎儿结局、胎儿分娩方式、分娩孕周及新生儿体重。数据采用单因素方差分析、Kruskal-Wallis检验和Fisher确切概率法进行统计学分析。治疗期间，早孕组、中孕组和晚孕组分别有4例、4例和2例患者发生创面感染，1例、3例和2例患者出现休克症状。3组之间差异无统计学意义(>0.05)。晚孕组1例患者清创后发生多器官功能障碍综合征。最后，所有孕妇均存活，3组之间差异无统计学意义(>0.05)。早孕组、中孕组和晚孕组存活胎儿例数分别为9例、8例和6例，差异无统计学意义(>0.05)。3组患者死胎、足月产等指标相近(>0.05)，而3组患者早产、流产情况差异有统计学意义(<0.05或<0.01)，早孕组流产例数最多，早产例数最少。3组存活胎儿患者的胎儿分娩方式、分娩孕周及新生儿体重差异无统计学意义(>0.05)。对于早、中、晚孕期烧伤患者，经及时充分的液体复苏、抗感染、创面处理及多学科综合管理等治疗后，可获得较高的母婴存活率。
