烧伤创面深度诊断技术的研究进展

刘一嘉; 吴鹏; 安纲; 方秋; 郑佳; 王一兵

doi:10.3760/cma.j.cn501120-20210518-00195

烧伤创面深度诊断技术的研究进展

doi: 10.3760/cma.j.cn501120-20210518-00195

刘一嘉¹,
吴鹏²,
安纲²,
方秋¹,
郑佳¹,
王一兵^2, ,

1.
山东中医药大学第一临床医学院，济南　　250061
2.
山东第一医科大学第一附属医院（山东省千佛山医院）整形外科，济南市组织工程皮肤再生与创面修复临床医学研究中心，济南　　250014

基金项目:

山东省重点研发计划 2019GSF108128

山东省自然科学基金重大基础研究项目 ZR2019ZD38

详细信息

通讯作者:
王一兵，Email：wyb0616@163.com

计量
- 文章访问数: 476
- HTML全文浏览量: 69
- PDF下载量: 84
- 被引次数: 0
出版历程
- 收稿日期: 2021-05-18

Research advances on the techniques for diagnosing burn wound depth

1.
The First Clinical Medical College,Shandong University of Traditional Chinese Medicine, Jinan 250061, China
2.
Department of Plastic Surgery, the First Affiliated Hospital (Shandong Provincial Qianfoshan Hospital), Shandong First Medical University, Jinan Clinical Medicine Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Jinan 250014, China

Funds:

Key Research and Development Program of Shandong Province of China 2019GSF108128

Major Basic Research Project of Shandong Provincial Natural Science Foundation of China ZR2019ZD38

More Information

Corresponding author: Wang Yibing, Email: wyb0616@163.com

摘要

摘要: 烧伤创面深度的准确诊断对评估烧伤患者病情的预后尤为重要，以往对于烧伤创面深度的诊断常依赖医师的主观判断，随着诊断技术的不断发展，烧伤创面深度的判定手段也获得了更新。该文主要汇总了吲哚菁绿血管造影、激光多普勒成像、激光散斑衬比成像和人工智能等技术在烧伤创面深度诊断中的应用研究进展，并比较这些技术的优点与不足，为烧伤创面深度的精确诊断提供思路。
- 烧伤 /
- 诊断 /
- 人工智能 /
- 创面深度 /
- 吲哚菁绿血管造影 /
- 激光多普勒成像 /
- 激光散斑衬比成像
Abstract: The accurate diagnosis of burn wound depth is particularly important for evaluating the disease prognosis of burn patients. In the past, the diagnosis of burn wound depth often relied on the subjective judgment of doctors. With the continuous development of diagnostic technology, the methods for judging the depth of burn wound have also been updated. This paper mainly summarizes the research progress in the applications of indocyanine green angiography, laser Doppler imaging, laser speckle contrast imaging, and artificial intelligence in the diagnosis of burn wound depth, and compares the advantages and disadvantages of these techniques, so as to provide ideas for accurate diagnosis of burn wound depth.
- Burns /
- Diagnosis /
- Artificial intelligence /
- Wound depth /
- Indocyanine green angiography /
- Laser Doppler imaging /
- Laser speckle contrast imaging
所有作者均声明不存在利益冲突

早期急性肾损伤（AKI）是严重烧伤患者常见的致命并发症。尽管近年来在液体复苏、重症监护和肾替代治疗（RRT）技术方面取得了显著进展，但严重烧伤AKI患者的发病率和病死率仍然相当高。作者对危重烧伤患者进行3年的单中心回顾性研究。纳入年龄在18岁以上、烧伤总面积≥30%TBSA的患者，观察到早期AKI的发生率与烧伤总面积、Ⅲ度烧伤面积、入院时简明烧伤严重指数（ABSI）、吸入性损伤、机械通气、心血管并发症和横纹肌溶解有关。多元logistic回归分析显示，烧伤总面积（比值比=0.224, P=0.007）、Ⅲ度烧伤面积（比值比=0.254, P=0.014）、ABSI（比值比=18.326, P=0.009）、横纹肌溶解（比值比=24.036, P=0.000）是发生早期AKI的独立危险因素。影响早期AKI严重程度的重要因素包括Ⅲ度烧伤、电烧伤和横纹肌溶解，Ⅲ度烧伤面积（比值比=1.437, P=0.041）和横纹肌溶解（比值比=5.401, P=0.035）也与患者病死率相关。在Cox模型中，经烧伤总面积、Ⅲ度烧伤面积、ABSI和横纹肌溶解校正后，AKI发生的死亡风险为5.407。死亡的3例患者均为AKI 3期，占AKI患者的8.3%（3/36）。接受和未接受早期RRT的3期AKI患者的病死率分别为33.3%和66.7%。该文结论：横纹肌溶解是危重烧伤患者发生早期AKI的独立危险因素，与烧伤严重程度密切相关；重度烧伤患者早期AKI发生率较高，但多为轻度；早期充分的液体复苏，及时有效的焦痂切开减张术，可降低横纹肌溶解的发生率和严重程度，多数可达到较好的预后。

李江锋，编译自《Burns》,2020，46(5):1100-1106；郇京宁，审校

HTML全文

参考文献(36)

[1]	XueEY,ChandlerLK,VivianoSL,et al.Use of FLIR ONE smartphone thermography in burn wound assessment[J].Ann Plast Surg,2018,80(4 Suppl 4):S236-238.DOI: 10.1097/SAP.0000000000001363.
[2]	PromnyD,BillnerM,ReichertB.Objektive tiefenbestimmung von verbrennungen der hand[J].Handchir Mikrochir Plast Chir,2019,51(5):362-366.DOI: 10.1055/a-0991-7869.
[3]	GreenHA,BuaD,AndersonRR,et al.Burn depth estimation using indocyanine green fluorescence[J].Arch Dermatol,1992,128(1):43-49.
[4]	SheridanRL,SchomakerKT,LucchinaLC,et al.Burn depth estimation by use of indocyanine green fluorescence: initial human trial[J].J Burn Care Rehabil,1995,16(6):602-604.DOI: 10.1097/00004630-199511000-00007.
[5]	WongkietkachornA,SurakunpraphaP,WinaikosolK,et al.Indocyanine green dye angiography as an adjunct to assess indeterminate burn wounds: a prospective, multicentered, triple-blinded study[J].J Trauma Acute Care Surg,2019,86(5):823-828.DOI: 10.1097/TA.0000000000002179.
[6]	MajlesaraA,GolrizM,HafeziM,et al.Indocyanine green fluorescence imaging in hepatobiliary surgery[J].Photodiagnosis Photodyn Ther,2017,17:208-215.DOI: 10.1016/j.pdpdt.2016.12.005.
[7]	HuQ,WangK,QiuL.6-Aminocaproic acid as a linker to improve near-infrared fluorescence imaging and photothermal cancer therapy of PEGylated indocyanine green[J].Colloids Surf B Biointerfaces,2021,197:111372.DOI: 10.1016/j.colsurfb.2020.111372.
[8]	谢小明吲哚菁绿荧光血管造影在颅内动脉瘤手术中的应用长沙中南大学2014 谢小明.吲哚菁绿荧光血管造影在颅内动脉瘤手术中的应用[D].长沙:中南大学,2014.
[9]	纪晓峰.烧伤创面深度的诊断技术和方法[J].继续医学教育,2007,21(13):15-20.DOI: 10.3969/j.issn.1004-6763.2007.13.003.
[10]	HoeksemaH,Van de SijpeK,TonduT,et al.Accuracy of early burn depth assessment by laser Doppler imaging on different days post burn[J].Burns,2009,35(1):36-45.DOI: 10.1016/j.burns.2008.08.011.
[11]	JanSN,KhanFA,BashirMM,et al.Comparison of Laser Doppler Imaging (LDI) and clinical assessment in differentiating between superficial and deep partial thickness burn wounds[J].Burns,2018,44(2):405-413.DOI: 10.1016/j.burns.2017.08.020.
[12]	AsifM,ChinAGM,LagzielT,et al.The added benefit of combining Laser Doppler Imaging with clinical evaluation in determining the need for excision of indeterminate-depth burn wounds[J].Cureus,2020,12(6):e8774.DOI: 10.7759/cureus.8774.
[13]	ClaesK,HoeksemaH,VynckeT,et al.Evidence based burn depth assessment using laser-based technologies: where do we stand?[J].J Burn Care Res,2021,42(3):513-525.DOI: 10.1093/jbcr/iraa195.
[14]	HoeksemaH,BakerRD,HollandAJ,et al.A new, fast LDI for assessment of burns: a multi-centre clinical evaluation[J].Burns,2014,40(7):1274-1282.DOI: 10.1016/j.burns.2014.04.024.
[15]	KaiserM,YafiA,CinatM,et al.Noninvasive assessment of burn wound severity using optical technology: a review of current and future modalities[J].Burns,2011,37(3):377-386.DOI: 10.1016/j.burns.2010.11.012.
[16]	CharuvilaS,SinghM,CollinsD,et al.A comparative evaluation of spectrophotometric intracutaneous analysis and laser Doppler imaging in the assessment of adult and paediatric burn injuries[J].J Plast Reconstr Aesthet Surg,2018,71(7):1015-1022.DOI: 10.1016/j.bjps.2018.03.014.
[17]	ClaesKEY,HoeksemaH,RobbensC,et al.The LDI enigma, part I: so much proof, so little use[J].Burns,2021,47(8):1783-1792.DOI: 10.1016/j.burns.2021.01.014.
[18]	PonticorvoA,BurmeisterDM,RowlandR,et al.Quantitative long-term measurements of burns in a rat model using Spatial Frequency Domain Imaging (SFDI) and Laser Speckle Imaging (LSI)[J].Lasers Surg Med,2017,49(3):293-304.DOI: 10.1002/lsm.22647.
[19]	HongJ,WangY,ChenX,et al.Fluctuations of temporal contrast in laser speckle imaging of blood flow[J].Opt Lett,2018,43(21):5214-5217.DOI: 10.1364/OL.43.005214.
[20]	CrouzetC,NguyenJQ,PonticorvoA,et al.Acute discrimination between superficial-partial and deep-partial thickness burns in a preclinical model with laser speckle imaging[J].Burns,2015,41(5):1058-1063.DOI: 10.1016/j.burns.2014.11.018.
[21]	ZhengKJ,MiddelkoopE,StoopM,et al.Validity of laser speckle contrast imaging for the prediction of burn wound healing potential[J].Burns,2022,48(2):319-327.DOI: 10.1016/j.burns.2021.04.028.
[22]	粘永健,陈志强,薛冬冬,等.烧伤深度诊断技术研究进展[J].中华烧伤杂志,2016,32(11):698-701.DOI: 10.3760/cma.j.issn.1009-2587.2016.11.014.
[23]	MirdellR,FarneboS,SjöbergF,et al.Accuracy of laser speckle contrast imaging in the assessment of pediatric scald wounds[J].Burns,2018,44(1):90-98.DOI: 10.1016/j.burns.2017.06.010.
[24]	MirdellR,FarneboS,SjöbergF,et al.Interobserver reliability of laser speckle contrast imaging in the assessment of burns[J].Burns,2019,45(6):1325-1335.DOI: 10.1016/j.burns.2019.01.011.
[25]	BriersD,DuncanDD,HirstE,et al.Laser speckle contrast imaging: theoretical and practical limitations[J].J Biomed Opt,2013,18(6):066018.DOI: 10.1117/1.JBO.18.6.066018.
[26]	LindahlF,TesselaarE,SjöbergF.Assessing paediatric scald injuries using Laser Speckle Contrast Imaging[J].Burns,2013,39(4):662-666.DOI: 10.1016/j.burns.2012.09.018.
[27]	KrezdornN,LimbourgA,PaprottkaFJ,et al.Assessing burn depth in tattooed burn lesions with LASCA imaging[J].Ann Burns Fire Disasters,2016,29(3):223-227.
[28]	ChenH,MiaoP,BoB,et al.A prototype system of portable laser speckle imager based on embedded graphics processing unit platform[J].Annu Int Conf IEEE Eng Med Biol Soc,2019,2019:3919-3922.DOI: 10.1109/EMBC.2019.8857273.
[29]	贲驰,李海航,刘彤,等.人工智能技术辅助烧伤深度诊断的研究进展[J].中华烧伤杂志,2020,36(3):244-246.DOI: 10.3760/cma.j.cn501120-20190403-00162.
[30]	WangG,LiW,ZuluagaMA,et al.Interactive medical image segmentation using deep learning with image-specific fine tuning[J].IEEE Trans Med Imaging,2018,37(7):1562-1573.DOI: 10.1109/TMI.2018.2791721.
[31]	圣文顺,孙艳文.卷积神经网络在图像识别中的应用[J].软件工程,2019,22(2):13-16.DOI: 10.19644/j.cnki.issn2096-1472.2019.02.004.
[32]	何志友,王元,张丕红,等.基于卷积神经网络的人工智能烧伤深度识别模型的建立及测试效果[J].中华烧伤杂志,2020,36(11):1070-1074.DOI: 10.3760/cma.j.cn501120-20190926-00385.
[33]	CirilloMD,MirdellR,SjöbergF,et al.Time-independent prediction of burn depth using deep convolutional neural networks[J].J Burn Care Res,2019,40(6):857-863.DOI: 10.1093/jbcr/irz103.
[34]	WangY,KeZ,HeZ,et al.Real-time burn depth assessment using artificial networks: a large-scale, multicentre study[J].Burns,2020,46(8):1829-1838.DOI: 10.1016/j.burns.2020.07.010.
[35]	PanSC,TsaiYH,ChuangCC,et al.Preliminary assessment of burn depth by paper-based ELISA for the detection of angiogenin in burn blister fluid-a proof of concept[J].Diagnostics (Basel),2020,10(3):127.DOI: 10.3390/diagnostics10030127.
[36]	OwdaAY,SalmonN,ShyloS,et al.Assessment of bandaged burn wounds using porcine skin and millimetric radiometry[J].Sensors (Basel),2019,19(13):2950.DOI: 10.3390/s19132950.