老年相对低热烧伤的临床特点与治疗分析
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摘要
目的探讨老年相对低热烧伤的伤情特点和临床治疗方法。方法回顾性分析36例老年相对低热烧伤的临床资料,患者年龄60～86岁,烧伤面积为0.5%～3%总体表面积(TBSA)。本组患者伤前均合并有基础性疾病,其中糖尿病22例,闭塞性脉管炎7例,偏瘫5例,阿尔兹海默病2例。治疗方法包括小面积Ⅲ度烧伤早期坏死组织切除后直接无张力拉拢缝合、局部皮瓣转移修复和中晚期肉芽组织创面自体皮片游离移植等。结果深Ⅱ度或混合Ⅱ度烧伤19.44%(7/36),Ⅲ度烧伤80.56%(29/36),烧伤部位以下肢为主66.67%(24/36),其次为腰背部、臀部、腹部和胸部。36例中伤后3 d内入院者11.11%(4/36),4～7 d者22.22%(8/36),>7 d者66.67%(24/36)。34例经早期手术治疗治愈出院,年龄>80岁而拒绝手术治疗的2例,后经门诊中药油膏纱布换药促其自愈,住院时间14～35 d(平均22 d)。结论相对低热烧伤早期易误诊而延误治疗,而且老年人机体免疫力弱且创面愈合能力差,并多伴有严重的基础性疾病,应在控制原发疾病的基础上,尽早手术治疗修复创面,以缩短疗程和防止并发症。
Objective To explore the clinical features and treatments of low heat burn in senile patients. Methods The clinical data of 36 senile patients with low heat burns were retrospectively analyzed in our hospital.The average age was ranged from 60 years to 86 years, and the burn surface area was 0.5%～3% total body surface area(TBSA). The 36 cases of senile patients were complicated with underlying diseases before injury, including 22 cases of diabetes, 7 cases of thromboangiitis obliterans, 5 cases of hemiplegia and 2 cases of Alzheimer's disease. Treatment methods were included direct tension-free suture after excision of necrotic tissue in early stage of small area third degree burns, transfered of local flaps to repair joint function sites, and free grafting of granulation tissue in middle and late stage. Results The 19.44%(7/36) were deep second-degree burns and mixed degree burns, and 80.56%(29/36) were third-degree burns. The burned area was mainly in lower extremities(66.67%, 24/36),and next were in lower backs, buttocks, abdomen and chests. The 11.11%(4/36)were admitted to the hospital within 3 days after burn, 22.22%(8/36)were 4 to 7 days,and 66.67%(24/36)were 7 days later after burn. Thirty-four cases of patients were cured and discharged after early surgical treatment. Two cases of patients aged over 80 years who refused surgical treatment were treated with traditional Chinese medicine ointment gauze to promote self-healing. Patients undergoing surgery were hospitalized for 14 to 35 days(average of 22 days). Conclusion Relatively low heat burn was easy to be misdiagnosed and delayed in the early stage. Because of the weak imm-unity,poor wound healing ability and more serious underlying diseases of the senile patients,it was necessary to treat and repair the wound as soon as possible on the basis of controlling the primary disease,so as to shorten the course of treatment and prevent complications.
Objective To explore the clinical features and treatments of low heat burn in senile patients. Methods The clinical data of 36 senile patients with low heat burns were retrospectively analyzed in our hospital.The average age was ranged from 60 years to 86 years, and the burn surface area was 0.5%～3% total body surface area(TBSA). The 36 cases of senile patients were complicated with underlying diseases before injury, including 22 cases of diabetes, 7 cases of thromboangiitis obliterans, 5 cases of hemiplegia and 2 cases of Alzheimer's disease. Treatment methods were included direct tension-free suture after excision of necrotic tissue in early stage of small area third degree burns, transfered of local flaps to repair joint function sites, and free grafting of granulation tissue in middle and late stage. Results The 19.44%(7/36) were deep second-degree burns and mixed degree burns, and 80.56%(29/36) were third-degree burns. The burned area was mainly in lower extremities(66.67%, 24/36),and next were in lower backs, buttocks, abdomen and chests. The 11.11%(4/36)were admitted to the hospital within 3 days after burn, 22.22%(8/36)were 4 to 7 days,and 66.67%(24/36)were 7 days later after burn. Thirty-four cases of patients were cured and discharged after early surgical treatment. Two cases of patients aged over 80 years who refused surgical treatment were treated with traditional Chinese medicine ointment gauze to promote self-healing. Patients undergoing surgery were hospitalized for 14 to 35 days(average of 22 days). Conclusion Relatively low heat burn was easy to be misdiagnosed and delayed in the early stage. Because of the weak imm-unity,poor wound healing ability and more serious underlying diseases of the senile patients,it was necessary to treat and repair the wound as soon as possible on the basis of controlling the primary disease,so as to shorten the course of treatment and prevent complications.
引文
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[8] 杨佳伟,曹桂军,李继华,等.负压封闭引流联合手术疗法治疗老年低热烧伤的疗效[J].中国老年学杂志,2014,34(9):2557-2558.
[9] 彭金霞,田诗政.低温烫伤创面的治疗与健康指导[J].中国美容医学,2015,24(17):16-17.
[2] 郑增强,刘凌风.低热烧伤特点及治疗[J].临床合理用药杂志,2011,4(10A):114.
[3] 韦殿闯.老年低热烧伤患者的临床特点及治疗分析[J].中外医疗,2013,33(8):64-66.
[4] 王娟,谢卫国,丁汉梅,等.武汉地区冬季低热烫伤住院患者的原因及人群特征分析[J].中华损伤与修复杂志(电子版),2013,8(3):266-269.
[5] 马文元,霍成,田社民,等.持续低热深度烧伤的实验室观察[J].中华烧伤杂志,2002,18(2):99-101.
[6] 刘承煌.老年皮肤的变化[J].临床皮肤科杂志,2003,32(2):113-114.
[7] 代涛,赵为民,雷万军.皮肤外科学基础与临床[M].北京:科学出版社,2018:178-179.
[8] 杨佳伟,曹桂军,李继华,等.负压封闭引流联合手术疗法治疗老年低热烧伤的疗效[J].中国老年学杂志,2014,34(9):2557-2558.
[9] 彭金霞,田诗政.低温烫伤创面的治疗与健康指导[J].中国美容医学,2015,24(17):16-17.