Clinical Analysis Of 137 Children With Severe Burns

Objective:Burns are a common and frequently-occurring disease in children’s trauma,and the disability rate of severe severe burns is high.In order to formulate corresponding preventive and diagnostic measures to reduce the incidence of severe severe burns in children,improve the cure rate and reduce the complications after burns Provide a clinical basis for reducing disability and mortality.Methods:Collected 137 cases of children with severe severe burns who had been hospitalized for burns and plastic surgery in the First Affiliated Hospital of Guangxi Medical University in the past 4 years from January 1,2015 to October31,2019.The retrospective statistical analysis was conducted on the injury season,urban-rural distribution,burn causes,burn area and depth,burn index,burn location,complications,wound infection status,wound treatment method,hospital stay and treatment outcome.Results:Among 137 children with severe burns:(1)Gender distribution:83(60.58%)boys and 54(39.42%)girls.The sex ratio of male to female is 1.54:1,and the ratio of boys is significantly higher than girls.Age range:101(73.72%)cases from 0-3 years old,21(15.33%)cases from 4-6 years old,and 15(10.95%)cases from 7-14 years old.(2)Causes of burns:117(85.40%)cases of hydrothermal burns,16(11.68%)cases of flame burns,and 4(2.92%)cases of chemical burns.The causes of burns in different age groups are different(χ~2=35.440,P=0.000<0.05).(3)Seasonal distribution:48(35.04%)cases in spring,40(29.20%)cases in winter,25(18.24%)cases in autumn,and 24(17.52%)cases in summer.(4)Urban-rural distribution:105(76.64%)cases in rural areas,32(23.36%)cases in urban areas,and a ratio of 3.28:1 between rural and urban areas.(5)The total burn area was 11%TBSA-90%TBSA,and the median was34(29.5,45)%TBSA.There were 9(6.75%)cases of superficial Ⅱ°burns,90(65.69%)cases of superficial Ⅱ°+deep Ⅱ°burns,and 38(27.74%)cases of superficial Ⅱ°+deep Ⅱ°+Ⅲ°burns.The burn depth composition caused by different burn causes is different(χ~2=17.820,P=0.000<0.05).(6)Involved sites:131(95.62%)cases with lower legs,129(94.16%)cases with trunk,107(78.10%)cases with upper arms,and 45(32.85%)cases with head,face and neck.(7)There were 13(9.49%)cases of hypovolemic shock admitted to the hospital.Hypovolemic shock was more likely to occur with inhalation injury(χ~2=5.907,P=0.015<0.05).(8)Complications:10(7.30%)cases of sepsis,4(2.92%)cases of myocardial damage,4(2.92%)cases of pneumonia,2(1.46%)cases of respiratory acidosis,ARDS 2(1.46%))Cases,heart failure 2(1.46%)cases,acute kidney injury 2(1.46%)cases,stress ulcers 2(1.46%)cases,gastrointestinal bleeding 2(1.46%)cases,infective endocarditis 1(0.73%)cases,1 pulmonary embolism(0.73%)case,pulmonary hemorrhage 1(0.73%)case,respiratory failure 1(0.73%)case,liver function impairment 1(0.73%)case.(9)Wound infection:A total of 46 Gram-negative bacteria,including 18 Pseudomonas aeruginosa(13.14%)strains,Acinetobacter baumannii 15(10.95%)strains,and Escherichia coli 5(3.65%)strains,Klebsiella pneumoniae 3(2.19%)strain,Enterobacter cloacae 2(1.46%)strain,Stenotrophomonas maltophilia 1(0.73%)strain,Pseudomonas putida 1(0.73%)strain,mucilage Serratia 1(0.73%)strain.A total of 12 strains of Gram-positive bacteria,including 5 strains of Staphylococcus aureus(3.65%),3 strains of MRSA(2.19%),3 strains of Enterococcus faecalis(2.19%),and 1 strain of Corynebacterium variabilis(0.73%)A total of 16 fungal infections,6(4.38%)Candida albicans,4(2.92%)Candida tropicalis,3(2.19%)Candida glabrata,1(0.73%)filamentous fungus,1 Mucor fungus(0.73%)strain,aspergillus 1(0.73%)strain.(10)Of the 121 patients cured,50(41.32%)cases were cured by simple dressing change,7(5.79%)cases were cured by biological dressing+dressing change,and skin graft transplantation+dressing cure was 64(52.89%)cases.After follow-up,a total of 20(16.53%)patients were seriously returned to the hospital due to scar hyperplasia to perform scar resection and deformity correction surgery,all of which were deep Ⅱ°-Ⅲ°burn wounds.Among the children who were cured by simple dressing change,There were 2 cases of re-hospitalization due to scars,and the median burn index was 15%(13.5%,17.5%)TBSA.Among the children cured by skin graft surgery,18 cases were re-hospitalized due to scars,and the median burn index was 24%(19%,24%)TBSA.(11)The length of hospitalization is 3-195 days,with a median of 20(13,31)days.Treatment outcomes were 121(88.32%)cured cases,with a cure rate of 99.18%;15(10.95%)cases of automatic discharge;1(0.73%)deaths,with a case fatality rate of 0.82%.The cause of death was breathing and circulation caused by sepsis Exhaustion.Conclusion:From January 1,2015 to October 31,2019,there have been 137 cases of severe burns in children who have been hospitalized for burns and plastic surgery in the First Affiliated Hospital of Guangxi Medical University for more than four years:(1)more than 3 years old,boys are more common,Frequent winter and spring seasons,more rural than urban,the most common cause of injury is hydrothermal scald,children with hydrothermal scald before 6 years old are more common,after 7 years old with flame burns.(2)The affected parts are more common in the limbs and trunk,and the depth is mainly Ⅱ°.The hot fluid scalds often cause Ⅱ°burns,and the flame burns and lime burns often cause Ⅲ°burns.(3)Hypovolemic shock is more likely to occur during concurrent inhalation injury.Complications are more common with sepsis.(4)Gram-negative bacteria are the main infections in burn wounds,mainly Pseudomonas aeruginosa,Acinetobacter baumannii and Escherichia coli;followed by Gram-positive bacteria,golden staphylococcus,MRSA and feces Enterococci are more common;fungal infections are more common with Candida albicans,followed by Candida tropicalis and Candida glabrata.(5)Superficial wounds of children can be cured by dressing treatment.Deep wounds require active surgery to improve the cure rate and reduce scar growth.