Epidemiological characteristics and treatment outcome analysis of 229 patients with hydrofluoric acid burns in hands
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摘要:
目的 探讨手部氢氟酸烧伤患者的流行病学特征及治疗结局。 方法 采用回顾性观察性研究方法。收集浙江衢化医院2008年1月—2020年12月收治的符合入选标准的229例手部氢氟酸烧伤患者的病历资料，统计患者的性别、年龄、所在企业类型、氢氟酸质量分数、烧伤部位、烧伤总面积、院前时间、住院天数、创面愈合天数、入院时是否有低钙血症和低镁血症、是否行手术治疗、有无瘢痕后遗症。采用单因素和多因素logistic回归分析筛选影响全部患者和氢氟酸质量分数已知的患者手术治疗和瘢痕后遗症的危险因素，采用单因素和多因素线性回归分析筛选影响全部患者和氢氟酸质量分数已知的患者创面愈合天数的危险因素。 结果 229例患者中男206例、女23例，年龄主要集中在30~50岁（139例），大部分患者的所在企业类型为非氟化工企业，仅91例患者的致伤氢氟酸质量分数已知（以中质量分数为主），常见的烧伤部位为手指中末节，烧伤总面积均≤1%体表总面积，院前时间为19（9，29）h，住院天数为2（1，7）d，创面愈合天数为12（8，18）d，入院时有低钙血症、低镁血症的比例分别为0.9%（2/229）、1.3%（3/229），36例患者行手术治疗，83例患者有瘢痕后遗症。针对229例患者，单因素logistic回归分析显示，所在企业类型、院前时间均是患者手术治疗（比值比分别为7.86、51.35，95%置信区间分别为1.83~33.76、11.89~221.78，P<0.01）和瘢痕后遗症（比值比分别为3.62、27.40，95%置信区间分别为1.76~7.43、13.25~56.68，P<0.01）的影响因素；多因素logistic回归分析显示，院前时间是影响患者手术治疗和瘢痕后遗症的独立危险因素（比值比分别为43.00、24.55，95%置信区间分别为9.89~187.03、11.78~51.16，P<0.01）；单因素线性回归分析显示，所在企业类型、院前时间均是患者创面愈合天数的影响因素（β值分别为6.16、12.83，95%置信区间分别为3.38~8.93、10.72~14.93，P<0.01）；多因素线性回归分析显示，所在企业类型、院前时间均是影响患者创面愈合天数的独立危险因素（β值分别为2.81、12.16，95%置信区间分别为0.50~5.13、10.00~14.31，P<0.05或P<0.01）。针对91例氢氟酸质量分数已知的患者，单因素logistic回归分析显示，所在企业类型、氢氟酸质量分数（低和高）、院前时间均是患者手术治疗的影响因素（比值比分别为9.10、11.25、10.69、0.04，95%置信区间分别为1.15~72.25、1.39~90.93、1.32~86.59、0.01~0.19，P<0.05或P<0.01），所在企业类型、氢氟酸质量分数、院前时间均是患者瘢痕后遗症的影响因素（比值比分别为0.32、0.21、36.80，95%置信区间分别为0.11~0.92、0.06~0.73、11.03~122.79，P<0.05或P<0.01）；多因素logistic回归分析显示，氢氟酸质量分数、院前时间均是影响患者手术治疗的独立危险因素（比值比分别为11.51、0.04，95%置信区间分别为1.22~108.26、0.01~0.25，P<0.05或P<0.01），院前时间是影响患者瘢痕后遗症的独立危险因素（比值比=37.71，95%置信区间为9.97~142.69，P<0.01）；单因素线性回归分析显示，所在企业类型、氢氟酸质量分数（低和高）、院前时间均是患者创面愈合天数的影响因素（β值分别为7.12、-5.63、-9.74、13.50，95%置信区间分别为2.43~11.81、-10.59~-0.68、-14.78~-4.70、10.14~16.86，P<0.05或P<0.01）；多因素线性回归分析显示，氢氟酸质量分数、院前时间均是影响患者创面愈合天数的独立危险因素（β值分别为-5.84、0.09，95%置信区间分别为-10.59~-1.08、0.05~0.12，P<0.05或P<0.01）。 结论 手部氢氟酸烧伤发病人群以中青年男性为主，所在企业类型、氢氟酸质量分数、院前时间是影响手部氢氟酸烧伤患者治疗结局的危险因素。 Abstract:Objective To explore the epidemiological characteristics and treatment outcomes of patients with hydrofluoric acid burns in hands. Methods A retrospective observational study was conducted. The medical records of 229 patients with hydrofluoric acid burns in hands who were admitted to Zhejiang Quhua Hospital from January 2008 to December 2020 and met the inclusion criteria were collected. The following statistical data of patients were collected, including gender, age, type of affiliated enterprise, hydrofluoric acid mass fraction, injury site, total burn area, prehospital time, length of hospital stay, length of wound healing, whether hypocalcemia and hypomagnesemia occurred or not on admission, whether surgery intervention was performed or not, and whether scar sequelae occurred or not. Single factor and multivariate logistic regression analysis were used to screen out the risk factors impacting surgery intervention and scar sequelae of all the patients and patients whose hydrofluoric acid mass fraction was known. Single factor and multivariate linear regression analysis were used to screen out the risk factors impacting the length of wound healing of all the patients and patients whose hydrofluoric acid mass fraction was known. Results The 229 patients included 206 males and 23 females, with the majority aged 30 to 50 years (139 patients). The type of affiliated enterprise of majority patients was non-fluorine chemical enterprise. The hydrofluoric acid mass fraction was known in only 91 patients, mainly medium. The majority injury site was in the middle and end of finger. The total burn area was below or equal to 1% total body surface area. The prehospital time was 19 (9, 29) h. The length of hospital stay was 2 (1, 7) d. The length of wound healing was 12 (8, 18) d. The proportions of hypocalcemia and hypomagnesemia were 0.9% (2/229) and 1.3% (3/229) on admission, respectively. Thirty-six patients had surgeries and 83 patients had scar sequelae. In 229 patients, single factor logistic regression analysis showed that both type of affiliated enterprise and prehospital time were the factors impacting surgery intervention (with odds ratio values of 7.86 and 51.35, respectively, 95% confidence intervals of 1.83-33.76 and 11.89-221.78, respectively, P<0.01) and scar sequelae of patients (with odds ratio values of 3.62 and 27.40, respectively, 95% confidence intervals of 1.76-7.43 and 13.25-56.68, respectively, P<0.01); multivariate logistic regression analysis showed that prehospital time was the independent risks factor impacting surgery intervention and scar sequelae of patients (with odds ratio values of 43.00 and 24.55, respectively, 95% confidence intervals of 9.89-187.03 and 11.78-51.16, respectively, P<0.01); single factor linear regression analysis showed that both type of affiliated enterprise and prehospital time were the factors impacting the length of wound healing of patients (with β values of 6.16 and 12.83, respectively, 95% confidence intervals of 3.38-8.93 and 10.72-14.93, respectively, P<0.01); multivariate linear regression analysis showed that both type of affiliated enterprise and prehospital time were the independent risk factors impacting the length of wound healing of patients (with β values of 2.81 and 12.16, respectively, 95% confidence intervals of 0.50-5.13 and 10.00-14.31, respectively, P<0.05 or P<0.01). In 91 patients whose hydrofluoric acid mass fraction was known, single factor logistic regression analysis showed that type of affiliated enterprise, hydrofluoric acid mass fraction (low and high), and prehospital time were all the factors impacting surgery intervention of patients (with odds ratio values of 9.10, 11.25, 10.69, and 0.04, respectively, 95% confidence intervals of 1.15-72.25, 1.39-90.93, 1.32-86.59, and 0.01-0.19, respectively, P<0.05 or P<0.01), type of affiliated enterprise, hydrofluoric acid mass fraction, and prehospital time were all the factors impacting scar sequelae of patients (with odds ratio values of 0.32, 0.21, and 36.80, respectively, 95% confidence intervals of 0.11-0.92, 0.06-0.73, and 11.03-122.79, respectively, P<0.05 or P<0.01); multivariate logistic regression analysis showed that both hydrofluoric acid mass fraction and prehospital time were the independent risk factors impacting surgery intervention of patients (with odds ratio values of 11.51 and 0.04, respectively, 95% confidence intervals of 1.22-108.26 and 0.01-0.25, respectively, P<0.05 or P<0.01), prehospital time was the independent risk factor impacting scar sequelae of patients (odds ratio=37.71, with 95% confidence interval of 9.97-142.69, P<0.01); single factor linear regression analysis showed that type of affiliated enterprise, hydrofluoric acid mass fraction (low and high), and prehospital time were all the factors impacting the length of wound healing of patients (with β values of 7.12, -5.63, -9.74, and 13.50, respectively, 95% confidence intervals of 2.43-11.81, -10.59--0.68, -14.78--4.70, and 10.14-16.86, respectively, P<0.05 or P<0.01); multivariate linear regression analysis showed that both hydrofluoric acid mass fraction and prehospital time were the independent risk factors impacting the length of wound healing of patients (with β values of -5.84 and 0.09, respectively, 95% confidence intervals of -10.59--1.08 and 0.05-0.12, respectively, P<0.05 or P<0.01). Conclusions The majority of patients with hydrofluoric acid burns in hands are young and middle-aged males. Type of affiliated enterprise, hydrofluoric acid mass fraction and prehospital time are the risk factors that affect the treatment outcomes of patients with hydrofluoric acid burns in hands. -
Key words:
- Burns, chemical /
- Hydrofluoric acid /
- Hand /
- Wound healing /
- Risk factors
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张曼佳：数据整理、论文撰写；毛书雷、张建芬：采集数据、分析数据；王新刚、张元海：撰写指导、论文修改；倪良方：数据整理、统计分析所有作者均声明不存在利益冲突
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参考文献
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1 例1右手第1~5指中质量分数氢氟酸烧伤患者情况。1A、1B.分别为伤后30 h，右手背侧、掌侧，第1~5指有水疱，第2~4指指甲呈暗紫色；1C、1D.分别为伤后31 h，右手背侧、掌侧，剪除水疱，拔除受累指甲后，基底呈灰褐色，指尖发黑；1E、1F.分别为伤后7 d，右手背侧、掌侧，第2~4指末节呈黑色干性坏死；1G.伤后20 d，带蒂腹部皮瓣血运良好；1H.伤后35 d，遗留第2~5指短缩
2 例2左手示指高质量分数氢氟酸烧伤患者情况。2A.伤后5 h，左手示指表皮呈苍白色；2B.伤后12 h，剪除水疱皮后，创面基底红润；2C.伤后5 d，创面部分愈合；2D.伤后30 d，创面未遗留瘢痕
表1 229例手部氢氟酸烧伤患者按是否行手术治疗和有无瘢痕后遗症分类的一般资料
项目与类别 例数 手术治疗 瘢痕后遗症 是 否 有 无 性别 男 206 30（14.6） 176（85.4） 74（35.9） 132（64.1） 女 23 6（26.1） 17（73.9） 9（39.1） 14（60.9） 年龄（岁） <45 127 20（15.7） 107（84.3） 48（37.8） 79（62.2） ≥45 102 16（15.7） 86（84.3） 35（34.3） 67（65.7） 所在企业类型 氟化工 63 1（1.6） 62（98.4） 11（17.5） 52（82.5） 非氟化工 166 35（21.1） 131（78.9） 72（43.4） 94（56.6） 氢氟酸质量分数 低 21 1（4.8） 20（95.2） 9（42.9） 12（57.1） 中 50 18（36.0） 32（64.0） 26（52.0） 24（48.0） 高 20 1（5.0） 19（95.0） 4（20.0） 16（80.0） 不详 138 16（11.6） 122（88.4） 44（31.9） 94（68.1） 院前时间（h） <24 147 2（1.4） 145（98.6） 18（12.2） 129（87.8） ≥24 82 34（41.5） 48（58.5） 65（79.3） 17（20.7） 低钙血症 有 2 1/2 1/2 2/2 0 无 227 35（15.4） 192（84.6） 81（35.7） 146（64.3） 低镁血症 有 3 0 3/3 0 3/3 无 226 36（15.9） 190（84.1） 83（36.7） 143（63.3） 注：除有低钙血症、有低镁血症患者的数据外，其余数据表达形式为例（%）；氢氟酸质量分数低为<20%、中为20%~50%、高为>50% 
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表2 影响229例手部氢氟酸烧伤患者手术治疗的单因素和多因素logistic回归分析结果
因素与分类 单因素分析 多因素分析 比值比 95%置信区间 P值 比值比 95%置信区间 P值 性别 男 1.00 — — — — — 女 2.07 0.76~5.67 0.157 — — — 年龄（岁） <45 1.00 — — — — — ≥45 1.06 0.52~2.17 0.873 — — — 所在企业类型 氟化工 1.00 — — 1.00 — — 非氟化工 7.86 1.83~33.76 0.006 3.85 0.80~18.54 0.093 院前时间（h） <24 1.00 — — 1.00 — — ≥24 51.35 11.89~221.78 <0.001 43.00 9.89~187.03 <0.001 注：比值比为1.00表示参照组；“—”表示无此项
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表3 影响91例氢氟酸质量分数已知的手部氢氟酸烧伤患者手术治疗的单因素和多因素logistic回归分析结果
因素与分类 单因素分析 多因素分析 比值比 95%置信区间 P值 比值比 95%置信区间 P值 性别 男 1.00 — — — — — 女 1.20 0.22~6.48 0.829 — — — 年龄（岁） <45 1.00 — — — — — ≥45 1.33 0.49~3.64 0.574 — — — 所在企业类型 氟化工 1.00 — — 1.00 — — 非氟化工 9.10 1.15~72.25 0.037 2.06 0.18~23.43 0.561 氢氟酸质量分数 中 1.00 — — 1.00 — — 低 11.25 1.39~90.93 0.023 11.51 1.22~108.26 0.033 高 10.69 1.32~86.59 0.026 1.79 0.14~22.84 0.654 院前时间（h） <24 1.00 — — 1.00 — — ≥24 0.04 0.01~0.19 <0.001 0.04 0.01~0.25 <0.001 注：氢氟酸质量分数低为<20%、中为20%~50%、高为>50%；比值比为1.00表示参照组；“—”表示无此项
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表4 影响229例手部氢氟酸烧伤患者瘢痕后遗症的单因素和多因素logistic回归分析结果
因素与分类 单因素分析 多因素分析 比值比 95%置信区间 P值 比值比 95%置信区间 P值 性别 男 1.00 — — — — — 女 1.15 0.47~2.78 0.762 — — — 年龄（岁） <45 1.00 — — — — — ≥45 0.93 0.54~1.61 0.807 — — — 所在企业类型 氟化工 1.00 — — 1.00 — — 非氟化工 3.62 1.76~7.43 <0.001 1.99 0.81~4.91 0.133 院前时间（h） <24 1.00 — — 1.00 — — ≥24 27.40 13.25~56.68 <0.001 24.55 11.78~51.16 <0.001 注：比值比为1.00表示参照组；“—”表示无此项
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表5 影响91例氢氟酸质量分数已知的手部氢氟酸烧伤患者瘢痕后遗症的单因素和多因素logistic回归分析结果
因素与分类 单因素分析 多因素分析 比值比 95%置信区间 P值 比值比 95%置信区间 P值 性别 男 1.00 — — — — — 女 0.77 0.18~3.27 0.719 — — — 年龄（岁） <45 1.00 — — — — — ≥45 0.97 0.42~2.26 0.939 — — — 所在企业类型 氟化工 1.00 — — 1.00 — — 非氟化工 0.32 0.11~0.92 0.034 0.80 0.18~3.51 0.766 氢氟酸质量分数 中 1.00 — — 1.00 — — 低 0.64 0.23~1.79 0.393 0.82 0.18~3.81 0.800 高 0.21 0.06~0.73 0.014 1.21 0.23~6.43 0.820 院前时间（h） <24 1.00 — — 1.00 — — ≥24 36.80 11.03~122.79 <0.001 37.71 9.97~142.69 <0.001 注：氢氟酸质量分数低为<20%、中为20%~50%、高为>50%；比值比为1.00表示参照组；“—”表示无此项
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表6 影响229例手部氢氟酸烧伤患者创面愈合天数的单因素和多因素线性回归分析结果
因素与分类 单因素分析 多因素分析 β值 95%置信区间 P值 β值 95%置信区间 P值 性别 男 0 — — — — — 女 0.81 -3.49~5.10 0.712 — — — 年龄（岁） <45 0 — — — — — ≥45 1.61 -0.98~4.21 0.222 — — — 所在企业类型 氟化工 0 — — 0 — — 非氟化工 6.16 3.38~8.93 <0.001 2.81 0.50~5.13 0.018 院前时间（h） <24 0 — — 0 — — ≥24 12.83 10.72~14.93 <0.001 12.16 10.00~14.31 <0.001 注：β值为0表示参照组；“—”表示无此项
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表7 影响91例氢氟酸质量分数已知的患者的手部氢氟酸烧伤患者创面愈合天数的单因素和多因素线性回归分析结果
因素与分类 单因素分析 多因素分析 β值 95%置信区间 P值 β值 95%置信区间 P值 性别 男 0 — — — — — 女 -2.09 -9.75~5.56 0.589 — — — 年龄（岁） <45 0 — — 0 — — ≥45 3.85 -0.54~8.24 0.085 3.16 -0.46~6.78 0.086 所在企业类型 氟化工 0 — — 0 — — 非氟化工 7.12 2.43~11.81 0.003 2.47 -1.97~6.91 0.273 氢氟酸质量分数 中 0 — — 0 — — 低 -5.63 -10.59~-0.68 0.026 -4.11 -8.54~-0.32 0.068 高 -9.74 -14.78~-4.70 <0.001 -5.84 -10.59~-1.08 0.017 院前时间（h） <24 0 — — 0 — — ≥24 13.50 10.14~16.86 <0.001 0.09 0.05~0.12 <0.001 注：氢氟酸质量分数低为<20%、中为20%~50%、高为>50%；β值为0表示参照组；“—”表示无此项
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