| BackgroundBurn was a kind of complex disease caused by heat, chemicals, current or radiation. It was not only a common trauma in the daily life and work, but also was one of the major war wounds. The severity of burn damage main influenced by burn area and depth except individual factors. After larger areas of burn, the skin or deep tissues was damaged, meanwhile many kind of organs and systems may show obvious changes of function, metabolism or morphology. Some patients may accompany with inhalation injury, craniocerebral trauma, fracture, ect. So the rescue of major burns was rather complex and difficult, it refered to many details, for instance shock, infection, immunity, nutrition, water electrolyte balance, wound treatment, skin-grafting, and function repairing. Major burn was an hot issues in burn surgery for a long time.From1950s, burn prevention and control work in our country had an great development and progress, formed a complete measures that suitable for our national condition. The overall treatment of major burns ranked in the advanced status in the world, the cure rate of patients whose burn area less than50%TBSA had reached98%and the cure rate of major burns whose burn area was50%TBSA and over had already closed to90%. However, many clinical data showed that there was not a much progress of clinical treatment in major burns in the recent10years, especially the mortality of patients whose burn area was over80%TBSA or the third-degree burn area was over50%TBSA was still very high. Although this part of patients only account for7%of all burns, the mortality was thirty times than patients with small and medium-sized burn area. This was the main influence factor to futher improving the cure rate of burns. Previous studies had identified inhalation injury, visceral complications and systemic infection were the main cause of burn death. The slow progress of clinical treatment in major burns had a relationship with the idea of people and the measures taken. So some scholars called for changing the ideas and patterns of burn treatment, enhancing early treatment, paying attention to preventing complications, changing improving the cure rate of complications to reducing the incidence of complications. Early conducting fluid resuscitation,early taking excision of large burn area and closeing the wound, using effective antibiotics in time, early intestional nutrition supporting and actively dealing with inhalation injury were the focus of major burns treatment and the effective measures to improving the treatment level of major burns.The province of Guangdong located in southern China, had hot and humid geographical enviroment, industrial and traffic were more developed, permanent and floating population were more, industrial and life burn crashed. For many times it was one of the main province of high burn incidence. The department of burns in Nanfang hospital established in1988, there were over ten thousand burns cured. Especially accummulated experience in the air ambulance of burns, the treatment of bulk burn patients, the storage of allogeneus and the preventing and controling of fungal infections. Meanwhile we also experienced many failures and lessons. The main problems were that the effect of major burns’treatment was not stable, severe complications occurred frequently, to futher improve the cure rate were difficult. Aimed at the three tasks of burn prevention and treatment, we collected the clinical data of extra severe burns in adult during1991to2010, using many statistical mothods to investigate the epidemiological features, the occurrence of complications and the main influencing factors of the prognosis to find out the relationship of eachother and provid references for the major burns treatment in the future.Objectives1. Retrospective analysis on the clinical data of adult cases who suffered extra severe burns to investigate the epidemiological features and the influence factors of the prognosis. Aiming to direct clinical treatment, judge prognosis, improve the cure rate of extra severe burn patients.2. Providing reference for the standardized treatment of major burns in our department.Material and methods1.Cases selection:The clinical data of extra severe burns whose burn area was80percent and over TBSA, the third-degree burn area was50percent and over TBS A, and age over15years old between January1991to December2010was collected. The data of burns who automatic discharged from the hospital due to the cost or turning to other hospitals were canceled。2.General data:One hundred and sixty three patients were involved in this research. There were142(87.1%) males and21(12.9%) females with a ratio of6.8:1. The mean age was33.06±11.67years(range15to85years). The mean of total burn area was85.91±10.01%TBSA, the mean of the third-degree burn area was57.38±27.01%TBSA. Flame was the main cause of burn.. Thereinto inhalation injury153(93.9%), combined injury14(8.6%). The mortality of the extra severe burns was19.6%. The main causes of the died patients were visceral complications, systemic infection and inhalation injury. There were4cases(12.5%) died within48hours,7cases died between3to7days,2cases died between8to14days,6cases died between15to30days,13cases died after31days.3.General treatment:Quickly assessed the injury after the patients admitted to the hosptal. Fluid resuscitation was carried out based on the domestic general formula and adjusted accordingly to the patient’s mind, heart rate and urine volume to maintain urine output above1ml/kg body weight/h. The patients who combined inhalation injury and conducted tracheotomy increased the proportion of water and the colloid supplement. Diagnostic fibrobronchoscopy was carried out in suspected inhalation injury patients and relaxied the tracheotomy indications, early used mechanical ventilation. Early prevented systemic infection and gastrointestinal ulcers. Used SD-Ag and iodine preventing wound infection after simple debridement and exposed the wound, early applied prophylactic antibiotics and subsequently tailored the antibiotics according to sensitivity profiles in the presence of positive cultures. After successful resuscitation and stabilization of the patients, the early excision of third-degree and second-degree deep burn areas and skin-grafting were carried out. The first session of early tangential excision was done within a week postburn. The extent of excision depended on the availability of the xenogenous or heterogeneous skins, the homografts and the intraoperative situation of the patients. Enteral alimentation was started on day3and gradually increased to its optimal need by days5or6postburn. Payed attention to the maintenance of visceras, prevented and curied the complications.4.Research methods:Devided the clinical data into two groups according to the outcome. The age, sex, burn area, depth and index, admission time, the incidence of inhalation injury, combined injury and tracheotomy, the application of fibrobronchoscope and respirator were compared between two groups. Also compared the condition of the shock stage and the disfunction of respiratory or kidney, gastrointestinal bleeding between two groups. The statistical significance index using the method of Binary Logistic analysis to screen out the correlative factors.5.Statistical Analysis:All data was analyzed by statistical software of SPSS13.0, using t test examine the difference of the measurement data. The count materials using the methods of Chi-square test to examine the difference. The statistical significance index using the method of Binary Logistic to screen out the correlative factors. P<0.05presents statistics difference.Results1. The result of t test between two groups showed that age presented difference(t=-2.035, P=0.044), burn area presented difference(t=-3.065, P=0.003), the third-degree burn area presented difference(t=-3.485, P=0.001), the burn index presented difference(t=-3.831, P=0.044). The result of Pearson χ2showed the condition of the shock stage presented difference(χ2=13.791, P<0.001), the disfunction of respiratory presented difference(χ2=53.383, P<0.001), the disfunction of kidney presented difference(χ2=41.042, P<0.001), the gastrointestinal bleeding presented difference(χ2=12.297, P<0.001), infection presented difference(χ2=7.708, P=0.005).2. The result of Binary Logistic showed the disfunction of respiratory and kidney were the risk factors influenced the prognosis of extra severe burn patients.Conclusions1.The Male of21-40years old had high incidence of extra severe burn. Flame was the main cause of burn.2.The main cause of death were the visceral complication and systemic infection.3. Age, burn area, the third-degree burn area and burn index, the instability of shock stage, infection, gastrointestinal bleeding and disfunction of respiratory or kidney had an relationship with the prognosis of extra severe burn patients. The disfunction of respiratory or kidney were the risk factors influenced the prognosis of extra severe burn patients.4.In the treatment of extra severe burn patients, taking active measurement reducing the incidence of complications, making focus on preventing and curing the disfunction of respiratory or kidney may reduce the mortality of them. |
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