Shirani K Z, Pruitt B A, Mason A D
Ann Surg. 1987 Jan;205(1):82-7. doi: 10.1097/00000658-198701000-00015.
In order to assess the specific effects of inhalation injury and pneumonia on mortality in burn patients, the records of 1058 patients treated at a single institution over a five-year period, 1980-1984, were reviewed. Of these patients, 373 (35%) had inhalation injury diagnosed by bronchoscopy and/or ventilation perfusion lung scan. Of the 373 patients, 141 (38%) had subsequent pneumonia. Among the patients without inhalation injury, pneumonia occurred in 60 of 685 (8.8%). A multiple logistic equation was developed to estimate expected mortality at any age and burn size for patients without either inhalation injury or pneumonia, with either alone, or with both. Subtraction of the expected mortality without either inhalation injury or pneumonia from the expected mortality in the presence of either or both permitted the estimation of additional mortality attributable to these complications. Inhalation injury alone increased mortality by a maximum of 20% and pneumonia by a maximum of 40%, with a maximum increase of approximately 60% when both were present. The influence on mortality was maximal in the midrange of expected mortality without these complications for any age group. These data indicate that inhalation injury and pneumonia have significant, independent, additive effects on burn mortality and that these effects vary with age and burn size in a predictable manner.
为评估吸入性损伤和肺炎对烧伤患者死亡率的具体影响，我们回顾了1980年至1984年期间在一家机构接受治疗的1058例患者的记录。在这些患者中，373例（35%）经支气管镜检查和/或通气灌注肺扫描诊断为吸入性损伤。在这373例患者中，141例（38%）随后发生了肺炎。在没有吸入性损伤的患者中，685例中有60例（8.8%）发生了肺炎。我们建立了一个多元逻辑方程，以估计无吸入性损伤或肺炎、仅有一种或两种情况都有的患者在任何年龄和烧伤面积时的预期死亡率。用存在一种或两种情况时的预期死亡率减去无吸入性损伤或肺炎时的预期死亡率，就可以估计出这些并发症导致的额外死亡率。仅吸入性损伤使死亡率最高增加20%，肺炎使死亡率最高增加40%，两种情况都存在时死亡率最高增加约60%。对于任何年龄组，在无这些并发症时预期死亡率的中等范围内，对死亡率的影响最大。这些数据表明，吸入性损伤和肺炎对烧伤死亡率有显著、独立、累加的影响，并且这些影响随年龄和烧伤面积以可预测的方式变化。
