特别重大火灾爆炸事故烧伤伤员的伤情特点
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摘要
目的探讨特别重大火灾爆炸事故烧伤伤员的伤情特点。方法回顾性分析某特别重大火灾爆炸事故烧伤伤员31例的一般情况(性别、年龄、职业等)、烧伤基本情况(烧伤面积、程度、部位、复合伤情况、手术次数及住院时间)、治疗及转归情况。比较普通病房与ICU烧伤伤员的临床特点。评价鼓膜穿孔对烧伤伤员爆炸肺损伤的预测效能。结果 31例烧伤伤员中位年龄27岁,均为男性,伤员烧伤深度为深Ⅱ度或深Ⅱ度合并Ⅲ度烧伤,并且以面部、四肢、颈部、头部居多;轻、中度烧伤为主,其中危重伤员9例,一般伤情伤员22例。以合并皮肤开放性外伤、眼部损伤、鼓膜穿孔最为常见。10名(32.3%)伤员进入ICU治疗;30名伤员病情好转后出院,1名(3.2%)伤员死亡。与普通病房伤员比较,ICU烧伤伤员总体烧伤程度较重,深Ⅱ度、Ⅲ度、总烧伤面积较大,手术次数较多,住院天数较长,合并吸入性损伤者比例及躯干烧伤者比例均较高(均P<0.05)。鼓膜穿孔预测爆炸肺损伤的受试者工作特征曲线下面积为0.590(P>0.05)。结论特大火灾爆炸事故中烧伤伤员伤情呈现一定的规律,熟练掌握批量烧伤伤员的伤情特点,可为今后各级医院开展火灾爆炸事故应急救援行动提供参考与借鉴。
Objective To explore the injury characteristics of burn patients in the devastating fire and explosion accident. Methods The data of 31 burn patients in a devastating fire and explosion accident were retrospectively analyzed,including the general information(gender,age and occupation),general condition of burn injuries(the extent,degree and site of burn,combined injury,operation frequency and hospital stay),therapy and outcome. The clinical features were compared between the ordinary burn patients and ICU burn patients. The efficiency of tympanic membrane perforation for predicting the explosion-related lung injury in burn patients was analyzed. Results The median age of 31 burn patients was 27 years. The patients were all males. The 31 burn patients suffered from the deep second degree burn or the deep second degree burn combined with the third degree burn. The most common sites of burn included face,extremities,neck and head. Mild or moderate burn was the main type. Nine patients were assessed as critical case and 22 patients as ordinary cases. Open skin trauma,ocular injury and tympanic membrane perforation were the main combined injuries. Ten patients(32. 3%) received therapy in ICU. Thirty patients were improved and discharged,and death occurred in one patient(3. 2%). Compared with the ordinary patients,the burn patients in ICU had more severe general burn degree,larger burn area of deep second degree and third degree,larger total burn area,more operation frequency,longer hospital stay,and higher proportion of the cases complicated with inhalation injury or trunk burn(all P < 0. 05). The area under the receiver operating characteristic curve for tympanic membrane perforation in predicting the explosion-related lung injury was 0. 590(P > 0. 05). Conclusion Certain laws are observed in the injury characteristics of burn patients in the devastating fire and explosion accident. A good master of the management for batches of burn patients can provide a reference for other hospitals at various levels to handle the similar fire and explosion accidents.
Objective To explore the injury characteristics of burn patients in the devastating fire and explosion accident. Methods The data of 31 burn patients in a devastating fire and explosion accident were retrospectively analyzed,including the general information(gender,age and occupation),general condition of burn injuries(the extent,degree and site of burn,combined injury,operation frequency and hospital stay),therapy and outcome. The clinical features were compared between the ordinary burn patients and ICU burn patients. The efficiency of tympanic membrane perforation for predicting the explosion-related lung injury in burn patients was analyzed. Results The median age of 31 burn patients was 27 years. The patients were all males. The 31 burn patients suffered from the deep second degree burn or the deep second degree burn combined with the third degree burn. The most common sites of burn included face,extremities,neck and head. Mild or moderate burn was the main type. Nine patients were assessed as critical case and 22 patients as ordinary cases. Open skin trauma,ocular injury and tympanic membrane perforation were the main combined injuries. Ten patients(32. 3%) received therapy in ICU. Thirty patients were improved and discharged,and death occurred in one patient(3. 2%). Compared with the ordinary patients,the burn patients in ICU had more severe general burn degree,larger burn area of deep second degree and third degree,larger total burn area,more operation frequency,longer hospital stay,and higher proportion of the cases complicated with inhalation injury or trunk burn(all P < 0. 05). The area under the receiver operating characteristic curve for tympanic membrane perforation in predicting the explosion-related lung injury was 0. 590(P > 0. 05). Conclusion Certain laws are observed in the injury characteristics of burn patients in the devastating fire and explosion accident. A good master of the management for batches of burn patients can provide a reference for other hospitals at various levels to handle the similar fire and explosion accidents.
引文
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[12]Wang D,Sava J,Sample G,et al.The Pentagon and 9/11[J].Crit Care Med,2005,33(1 Suppl):S42-S47.
[13]Cushman JG,Pachter HL,Beaton HL.Two New York City hospitals'surgical response to the September 11,2001,terrorist attack in New York City[J].J Trauma,2003,54(1):147-154.
[14]Kauvar DS,Wolf SE,Wade CE,et al.Burns sustained in combat explosions in Operations Iraqi and Enduring Freedom(OIF/OEF explosion burns)[J].Burns,2006,32(7):853-857.
[15]Chim H,Yew WS,Song C.Managing burn victims of suicide bombing attacks:outcomes,lessons learnt,and changes made from three attacks in Indonesia[J].Crit Care,2007,11(1):R15.
[16]Zengin Y,Dursun R,ⅰ9er M,et al.Fire disaster caused by LPG tanker explosion at Lice in Diyarbakr(Turkey):July21,2014[J].Burns,2015,41(6):1 347-1 352.
[17]De Palma RG,Burris DG,Champion HR,et al.Blast injuries[J].N Engl J Med,2005,352(13):1 335-1 342.
[18]Radford P,Patel HD,Hamilton N,et al.Tympanic membrane rupture in the survivors of the July 7,2005,London bombings[J].Otolaryngol Head Neck Surg,2011,145(5):806-812.
[2]聂志勇,丁日高,王汉斌,等.“天津港8·12特大爆炸事故”防化应急处置经验与启示[J].中国药理学与毒理学杂志,2015(5):842-846.
[3]柴家科,盛志勇,陆江阳,等.成批烧冲复合伤患者的临床救治[J].中华创伤杂志,2007,23(1):57-61.
[4]Yu M,Lv Q,Ding H,et al.Evaluation of blast injury patients from the 2015 Tianjin explosions in China[J].Burns,2016,42(5):1 133-1 140.
[5]陈孝平,汪建平.外科学[M].第8版.北京:人民卫生出版社,2013:138-148.
[6]中华医学会创伤学分会.天津港8·12大爆炸伤员伤情特点与救治反思[J].中华创伤杂志,2015,31(9):810-813.
[7]王欢,何久智,陈孝储,等.特别重大火灾爆炸事故眼耳部损伤伤员伤情分析[J].解放军预防医学杂志,2017,35(4):317-319,323.
[8]刘秀,王欢,陈孝储,等.特别重大火灾爆炸事故住院伤员外伤伤情分析[J].解放军预防医学杂志,2017,35(4):314-316,337.
[9]何久智,孙圣凯,靳景云,等.特大火灾爆炸事故烧伤伤员专科护理应对[J].解放军预防医学杂志,2017,35(4):406-408.
[10]Gutierrez de Ceballos JP,Turégano Fuentes F,Perez Diaz D,et al.Casualties treated at the closest hospital in the Madrid,March 11,terrorist bombings[J].Crit Care Med,2005,33(1 Suppl):S107-S112.
[11]De Ceballos JP,Turégano-Fuentes F,Perez-Diaz D,et al.11March 2004:the terrorist bomb explosions in Madrid,Spain--an analysis of the logistics,injuries sustained and clinical management of casualties treated at the closest hospital[J].Crit Care,2005,9(1):104-111.
[12]Wang D,Sava J,Sample G,et al.The Pentagon and 9/11[J].Crit Care Med,2005,33(1 Suppl):S42-S47.
[13]Cushman JG,Pachter HL,Beaton HL.Two New York City hospitals'surgical response to the September 11,2001,terrorist attack in New York City[J].J Trauma,2003,54(1):147-154.
[14]Kauvar DS,Wolf SE,Wade CE,et al.Burns sustained in combat explosions in Operations Iraqi and Enduring Freedom(OIF/OEF explosion burns)[J].Burns,2006,32(7):853-857.
[15]Chim H,Yew WS,Song C.Managing burn victims of suicide bombing attacks:outcomes,lessons learnt,and changes made from three attacks in Indonesia[J].Crit Care,2007,11(1):R15.
[16]Zengin Y,Dursun R,ⅰ9er M,et al.Fire disaster caused by LPG tanker explosion at Lice in Diyarbakr(Turkey):July21,2014[J].Burns,2015,41(6):1 347-1 352.
[17]De Palma RG,Burris DG,Champion HR,et al.Blast injuries[J].N Engl J Med,2005,352(13):1 335-1 342.
[18]Radford P,Patel HD,Hamilton N,et al.Tympanic membrane rupture in the survivors of the July 7,2005,London bombings[J].Otolaryngol Head Neck Surg,2011,145(5):806-812.