| Objective:To retrospectively analyze the epidemiological characteristics and the clinical features of early organ damage and its influences on the prognosis in elderly patients with severe burns,and to provide evidence for promoting its prevention and treatment.Methods:1.Medical records of patients who were treated in the Institute of Burn Research of Southwest Hospital,Army Medical University(Third Military Medical University,hereinafter referred to as the author’s affiliation)from January 2009 to December 2018,and simultaneously met the inclusion criteria were collected.The demographic characteristics,injury situation,injury characteristics,treatment and outcome of elderly patients with severe burn were statistically analyzed.Data was processed with chi-square test,Fisher exact probability test,Kruskal-Wallis test,Mann-Whitney U test,and Logistic regression analysis.2.Among the patients who were treated in the the author’s affiliation from January 2010to August 2018,and simultaneously met the inclusion criteria,62 patients were included in the elderly group,and 124 patients were included in the young and middle-aged group.Treatment of patients in the two groups followed the conventional procedures of our hospital.The following data of the two groups of patients were collected.(1)The data of fluid replacement volume,urine volume within the first and second post injury hour(PIH)24,the hemoglobin,haematocrit and blood lactic acid at admission and PIH 24,48 were recorded.(2)The myocardial creatine kinase isozyme(CK-MB),total bilirubin,blood creatinine,oxygenation index and platelet count at admission,shock stage and post injury day(PID)3-7were collected.(3)The days of seriously or critically ill and deaths.Data was processed with chi-square test,group T test,Mann-Whitney U test,and Repeated Measures ANOVA and Bonferroni correction.Results:1.The single-center study on Epidemiological characteristics in elderly patients with severe burns1.1 Elderly patients accounted for 8.7%of all patients with severe burns in the same period.There was no significant difference in the incidence of severe burns in the elderly before and after five years(?~2=2.307,P>0.05).The age distribution ranges from 60 to 89years and the average age was 67.0±10.5 years.The majority were male(65.0%)and aged60-69 years(62.9%).No differences in the gender distribution between different age groups,different burn sites,different injury factors and different burn severity was found(?~2=1.396,3.467,1.163,0.718,P>0.05).1.2 The majority of severe burns in the elderly occurred at family(69.1%)and in summer(36.1%),the main cause was flame(84.5%).1.3 The incidence of co-morbid disease in elderly patients with severe burns was 53.6%.Most of these patients were complicated with cardiovascular(34%),of which hypertension was identified as a major co-morbid factor(27.8%).1.4 The total burn surface area of elderly patients with severe burn was 31%to 92%TBSA,the average was 45.0±20.0%TBSA;79.4%of them were complicated with third degree burn,among which the average area of third degree burn was 18.0±32.5%TBSA;39.2%of the patients were complicated with inhalation injury.The time of admission to hospital was from 2 h to 30 d after injury.Most of them were admitted to hospital at 6~48hours after injury(45.4%).1.5 The average length of stay(LOS)in hospital and days of seriously or critically ill was 17.0±41.0 days and 8.0±15.5 days,respectively.The majority of these patients(52.6%)received surgery during hospitalization.The average hospital cost was 107410.0±213563.0RMB and 2421.0±4674.0 RMB per 1%TBSA.There was no significant difference in the proportion of surgical treatment,the cost of treatment,the days of hospitalization and the days of serious illness and danger among the elderly patients with different severity of burn(?~2=0.345,1.215,5.414,0.163,P>0.05).With the increase of age,the proportion of patients receiving surgical treatment,the cost of treatment and the days of hospitalization showed a significant decline(?~2=7.055,10.572,16.506,P(27)0.05 or 0.01).1.6 The mortality of elderly patients with severe burns was 24.7%,and the average time of death was 19.2±17.6 days after injury,and automatic discharge was the most common in the treatment outcome(60.8%).Besides,The TBSA of burns and the presence of inhalation injury were independent risk factors for death in elderly patients with severe burn(OR=2.045,3.506,95%CI 1.024-4.083,1.307-9.406,P(27)0.05).2.The study on the characteristics of early organ damage in elderly patients with severe burns2.1 The urine volume within the first PIH 24 in elderly group was notably less than that in middle-aged group(t=5.628,P<0.05).But no significant difference was found in the fluid replacement volume within the first and second PIH 24,and urine volume within the second PIH 24 between the two groups(t=0.351,1.307,1.110,P>0.05);and no significance was observed in hemoglobin,haematocrit and blood lactic acid at admission,and PIH 24,48between the two groups(t=0.011,1.075,0.239,0.000,0.033,0.199,0.017,1.002,0.739,P>0.05).2.2 The CK-MB of elderly group was remarkably higher than that in young and middle-aged group at shock stage(t=4.017,P<0.05).While no statistical significance was showed between the two groups at admission and PID 3-7(t=0.069,0.001,P>0.05).The total bilirubin of elderly group had significantly higher total bilirubin than young and middle-aged group at shock stage(t=6.485,P<0.05).However,no statistical significance was showed at admission and PID 3-7(t=0.227,0.002,P>0.05).The blood creatinine of elderly group was notably higher than that of young and middle-aged group at admission and shock stage(t=4.226,12.299,P<0.05,P<0.01),while no significant difference was observed at PID 3-7(t=0.693,P>0.05).At admission,shock stage and PID 3-7,the oxygenation indexes of elderly group were(371±16),(263±16)and(228±18)mmHg,lower than that of young and middle-aged group which were(420±13),(327±13)and(371±16)mmHg(t=5.650,9.782 and 4.856,P<0.05 or P<0.01).The elderly group had lower blood platelet count than young and middle-aged group at 3-7 days post-burn(t=6.636,P<0.05).while no difference was showed between two groups at admission and shock stage(t=0.038,0.588,P>0.05).2.3 Compared with young and middle-aged group,the elderly group showed longer periods of seriously or critically ill as well as higher mortalities(Z=-2.33,?~2=13.676,P<0.05 or P<0.001).Conclusions:1.Although the proportion of elderly patients with severe burn is not high,but the pre-injury comorbidities are more common and the mortality is high.Aging 60 to 69,males were the high risk group of severe burn in the elderly.Summer,flame burn and family were the high risk factors of severe burn in the elderly,and the desire to treat decreased with the increase of age.TBSA and inhalation injury were independent risk factors for death in elderly patients with severe burn.2.In the case of the same tissue perfusion at shock stage,the damages in heart,liver,kidney,lung,and coagulation system in elderly patients with severe burns are more obvious than those in young and middle-aged patients,with more seriously ill and higher mortality. |
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