高压电烧伤进行性损伤的机制及防治策略

张庆富; 郝嘉文

doi:10.3760/cma.j.cn501225-20230331-00107

高压电烧伤进行性损伤的机制及防治策略

doi: 10.3760/cma.j.cn501225-20230331-00107

张庆富^1, ,,
郝嘉文²

1.
河北医科大学第三医院烧伤与创面修复中心，河北省烧伤救治技术创新中心，石家庄　　050051
2.
河北医科大学第一医院烧伤整形（创面修复）科，石家庄　　050000

基金项目:

国家自然科学基金面上项目 81871560

河北省自然科学基金重点项目 H2016206575

河北省创新能力提升计划项目 225676120H

详细信息

通讯作者:
张庆富，Email：zhangqfdoctor@163.com

计量
- 文章访问数: 799
- HTML全文浏览量: 81
- PDF下载量: 58
- 被引次数: 0
出版历程
- 收稿日期: 2023-03-31

Mechanism and prevention and treatment strategy of progressive injury in high-voltage electric burns

Zhang Qingfu^{1
, ,},
Hao Jiawen²

1.
Burn and Wound Repair Center, the Third Hospital of Hebei Medical University, Hebei Burn Treatment Technology Innovation Center, Shijiazhuang 050051, China
2.
Department of Burn Plastic (Wound Repair) Surgery, the First Hospital of Hebei Medical University, Shijiazhuang 050000, China

Funds:

General Program of National Natural Science Foundation of China 81871560

Key Project of Hebei Provincial Natural Science Foundation H2016206575

Hebei Provincial Innovation Ability Improvement Plan Project 225676120H

More Information

Corresponding author: Zhang Qingfu, Email: zhangqfdoctor@163.com

摘要

摘要: 高压电烧伤是各种烧伤中对组织器官毁损较为严重的一种。临床上，高压电烧伤进行性损伤是影响截肢平面及救治成功率的关键病理变化，目前其确切的定义和发生机制尚未被阐明，临床治疗以对症处理为主，而针对高压电烧伤进行性损伤机制及治疗的相关研究资料匮乏。该文通过分析和总结高压电烧伤进行性损伤的发生机制、诊断和治疗及常见结局，为高压电烧伤进行性损伤的机制研究和临床诊断与治疗提供参考依据。
- 烧伤，电 /
- 软组织损伤 /
- 外科皮瓣 /
- 截肢，创伤性 /
- 诊断
Abstract: High-voltage electric burn is one of burns that can cause severe damages to tissue and organs. Clinically, progressive injury in high-voltage electric burns is a key pathological change that affects the level of amputation and the success rate of treatment. At present, the exact definition and mechanism of progressive injury in high-voltage electric burns have not been elucidated, and the clinical treatment is mainly symptomatic treatment. Relevant research data on the mechanism and treatment of progressive injury in high-voltage electric burns are lacking. This paper analyzes and summarizes the mechanism, diagnosis, treatment, and common outcome of progressive injury in high-voltage electric burns, and provides a reference for the mechanism research, clinical diagnosis and treatment of progressive injury in high-voltage electric burns.
- Burns, electric /
- Soft tissue injuries /
- Surgical flaps /
- Amputation, traumatic /
- Diagnosis
所有作者均声明不存在利益冲突

HTML全文

参考文献(40)

[1]	AzzenaB,Tocco-TussardiI,PontiniA,et al.Late complications of high-voltage electrical injury might involve multiple systems and be related to current path[J].Ann Burns Fire Disasters,2016,29(3):192-194.
[2]	ShihJG,ShahrokhiS,JeschkeMG.Review of adult electrical burn injury outcomes worldwide: an analysis of low-voltage vs high-voltage electrical injury[J].J Burn Care Res,2017,38(1):e293-e298.DOI: 10.1097/BCR.0000000000000373.
[3]	孙永华.我国电烧伤治疗的成就与挑战[J].中华烧伤杂志,2008,24(5):381-383.DOI: 10.3760/cma.j.issn.1009-2587.2008.05.022.
[4]	蒋梅君,李泽,谢卫国. 2 133例电烧伤住院患者流行病学调查[J] .中华烧伤杂志,2017,33(12):732-737. DOI: 10.3760/cma.j.issn.1009-2587.2017.12.003.
[5]	杨宗城.中华烧伤医学[M].北京:人民卫生出版社,2008:658-660.
[6]	FanX,MaB,ZengD,et al.Burns in a major burns center in East China from 2005 to 2014: incidence and outcome[J].Burns,2017,43(7):1586-1595.DOI: 10.1016/j.burns.2017.01.033.
[7]	DingH,HuangM,LiD,et al.Epidemiology of electrical burns: a 10-year retrospective analysis of 376 cases at a burn centre in South China[J].J Int Med Res,2020,48(3):300060519891325.DOI: 10.1177/0300060519891325.
[8]	SaracogluA, KuzucuogluT, YakupogluS, et al. Prognostic factors in electrical burns: a review of 101 patients[J]. Burns, 2014,40(4):702-707. DOI: 10.1016/j.burns.2013.08.023.
[9]	GoyalD,JagneN,DhimanA,et al.High voltage electrical injuries: outcomes & 1-year follow-up from a level 1 trauma centre[J].Int J Burns Trauma,2021,11(2):115-122.
[10]	MongaK,GoilP.Single-stage composite reconstruction of complex electrical burn defects by microvascular techniques - a prospective study[J].Ann Burns Fire Disasters,2021,34(1):75-82.
[11]	Batista NapotnikT,PolajžerT,MiklavčičD.Cell death due to electroporation - a review[J].Bioelectrochemistry,2021,141:107871.DOI: 10.1016/j.bioelechem.2021.107871.
[12]	GalluzziL,VitaleI,AaronsonSA,et al.Molecular mechanisms of cell death: recommendations of the Nomenclature Committee on Cell Death 2018[J].Cell Death Differ,2018,25(3):486-541.DOI: 10.1038/s41418-017-0012-4.
[13]	SalibianAA,RosarioA,SeveroL,et al.Current concepts on burn wound conversion-a review of recent advances in understanding the secondary progressions of burns[J].Burns,2016,42(5):1025-1035.DOI: 10.1016/j.burns.2015.11.007.
[14]	张庆富,李勇,冯建科,等.高压电烧伤大鼠血小板流变行为变化及乌司他丁的干预效果[J].中华烧伤杂志,2017,33(12):744-749.DOI: 10.3760/cma.j.issn.1009-2587.2017.12.005.
[15]	张庆富.烧伤后血小板流变行为及其调节研究进展[J].中华烧伤杂志,2014,30(1):56-60.DOI: 10.3760/cma.j.issn.1009-2587.2014.01.014.
[16]	ZimmermanJL,ShenMC.Rhabdomyolysis[J].Chest,2013,144(3):1058-1065.DOI: 10.1378/chest.12-2016.
[17]	黎淑娟,王正磊,朱维平,等.四肢高压电烧伤早期磁共振成像特点的临床研究[J].中华烧伤杂志,2017,33(12):750-756.DOI: 10.3760/cma.j.issn.1009-2587.2017.12.006.
[18]	孙斯琴,郭威,陈军,等.兔肢体高压电烧伤后骨骼肌MRI特征[J].放射学实践,2022,37(5):605-610.DOI: 10.13609/j.cnki.1000-0313.2022.05.014.
[19]	李利根,柴家科.肢体高压电烧伤软组织及血管损伤的影像学判断及临床意义[J].中华烧伤杂志,2020,36(11):1009-1012.DOI: 10.3760/cma.j.cn501120-20190904-00371.
[20]	颜莘,张明谏,李小兵,等.封闭负压吸引技术对电烧伤创面间生态组织保护作用临床研究[J].天津医药,2012,40(6):618-620.DOI: 10.3969/j.issn.0253-9896.2012.06.029.
[21]	谭红,张伟,谢卫国,等.大鼠肢体电烧伤模型的病理学变化[J].中华实验外科杂志,2007,24(6):763.DOI: 10.3760/j.issn:1001-9030.2007.06.050.
[22]	HueiTJ,Mohd YussofSJ,LipHTC,et al.Case report of a high voltage electrical injury and review of the indications for early fasciotomy in limb salvage of an electrically injured limb[J].Ann Burns Fire Disasters,2017,30(2):150-153.
[23]	PannucciCJ,OsborneNH,JaberRM,et al.Early fasciotomy in electrically injured patients as a marker for injury severity and deep venous thrombosis risk: an analysis of the National Burn Repository[J].J Burn Care Res,2010,31(6):882-887.DOI: 10.1097/BCR.0b013e3181f93597.
[24]	AyazM.High voltage electrical injury, early vs. late wound excision, and coverage[J].Burns,2020,46(6):1476-1477.DOI: 10.1016/j.burns.2020.04.043.
[25]	张丕红.加强规范化诊治改善电烧伤预后[J].中华烧伤杂志,2019,35(11):772-775.DOI: 10.3760/cma.j.issn.1009-2587.2019.11.002.
[26]	KleinMB,HunterS,HeimbachDM,et al.The Versajet water dissector: a new tool for tangential excision[J].J Burn Care Rehabil,2005,26(6):483-487.DOI: 10.1097/01.bcr.0000185398.13095.c5.
[27]	CiernyG3rd,ByrdHS,JonesRE.Primary versus delayed soft tissue coverage for severe open tibial fractures. A comparison of results[J].Clin Orthop Relat Res,1983(178):54-63.
[28]	SauerbierM,OferN,GermannG,et al.Microvascular reconstruction in burn and electrical burn injuries of the severely traumatized upper extremity[J].Plast Reconstr Surg,2007,119(2):605-615.DOI: 10.1097/01.prs.0000246512.47204.da.
[29]	JabirS,FrewQ,MagdumA,et al.Microvascular free tissue transfer in acute and secondary burn reconstruction[J].Injury,2015,46(9):1821-1827.DOI: 10.1016/j.injury.2015.04.029.
[30]	CastroJC,ColtroPS,MillanLS,et al.Early application of microsurgical flaps in the electric burns of extremities: a two institutional case series[J].J Burn Care Res,2018,39(6):1037-1042.DOI: 10.1093/jbcr/irx010.
[31]	张庆富,周慧敏,王车江,等.高压电烧伤家兔骨骼肌微循环灌流量变化及己酮可可碱的干预作用[J].微循环学杂志,2013,23(2):37-39,封4.DOI: 10.3969/j.issn.1005-1740.2013.02.015.
[32]	邵洪波,张庆富.己酮可可碱对高压电烧伤病人创面微循环的影响[J].中国血液流变学杂志,2012,22(2):223-224,227.DOI: 10.3969/j.issn.1009-881X.2012.02.012.
[33]	张庆富,周慧敏,王车江.经颅高压电烧伤对大鼠肠系膜微血管白细胞流变行为的影响及乌司他丁干预作用[J].中华烧伤杂志,2011,27(5):375-380.DOI: 10.3760/cma.j.issn.1009-2587.2011.05.015.
[34]	薛欣高压电烧伤大鼠血清TSP、vWF变化及乌司他丁、甲基强的松龙干预作用石家庄河北医科大学 2013 薛欣. 高压电烧伤大鼠血清TSP、vWF变化及乌司他丁、甲基强的松龙干预作用[D].石家庄:河北医科大学,2013.
[35]	王成,沈余明,覃凤均,等.应用肌皮瓣修复上肢高压电烧伤深度创面的临床效果探讨[J].中国医刊,2020,55(3):290-293.DOI: 10.3969/j.issn.1008-1070.2020.03.017.
[36]	Gacto-SanchezP.Surgical treatment and management of the severely burn patient: review and update[J].Med Intensiva,2017,41(6):356-364.DOI: 10.1016/j.medin.2017.02.008.
[37]	AghakhaniK,HeidariM,TabatabaeeSM,et al.Effect of current pathway on mortality and morbidity in electrical burn patients[J].Burns,2015,41(1):172-176.DOI: 10.1016/j.burns.2014.06.008.
[38]	GürünlüoğluK,DemircanM,TaşçiA,et al.Effects of high-voltage electrical burns and other burns on levels of serum oxidative stress and telomerase in children[J].Burns,2018,44(8):2034-2041.DOI: 10.1016/j.burns.2018.07.001.
[39]	CelikA,ErgünO,OzokG.Pediatric electrical injuries: a review of 38 consecutive patients[J].J Pediatr Surg,2004,39(8):1233-1237.DOI: 10.1016/j.jpedsurg.2004.04.004.
[40]	ArnoldoB,KleinM,GibranNS.Practice guidelines for the management of electrical injuries[J].J Burn Care Res,2006,27(4):439-447.DOI: 10.1097/01.BCR.0000226250.26567.4C.