Analysis of effects of discipline cooperation on rescue and treatment of severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident
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摘要: 目的 分析烧伤外科与重症医学科医师合作在"八二"昆山工厂铝粉尘爆炸事故群体特重度烧伤患者救治中的作用。 方法 2014年8月2日,苏州大学附属第二医院重症医学科临时成立的"烧伤救治中心"收治15例"八二"昆山工厂铝粉尘爆炸事故造成的特重度烧伤患者,平均分成3个小组,每个小组5例。将来自全国各地的15名烧伤外科医师、30名烧伤外科护士、15名重症医学科医师及30名重症医学科护士均分成3个小组,每个小组由5名烧伤外科医师、10名烧伤外科护士、5名重症医学科医师、10名重症医学科护士组成,负责5例患者。治疗方案以烧伤外科医师意见为主,烧伤外科医师主要负责患者创面处理及手术治疗,重症医学科医师主要负责全身治疗及各种仪器参数调整。观测患者休克期补液量、尿量,治疗期间严重并发症发生情况,抗生素应用时间和种类,入院后1个月病死情况,住院时间及救治成功情况。 结果 15例特重度烧伤患者伤后第1个24 h补液量10 360~17 162(12 998±1 811)mL,即(1.62±0.23)mL·%体表总面积(TBSA)-1·kg-1电解质、胶体+(2 850±232)mL葡萄糖,电解质、胶体比为(1.76±0.23)∶1.00;伤后第1个24 h尿量为(2 384±1 242)mL,每小时尿量为(99±52)mL。伤后第2个24 h补液量为8 720~11 616(9 406±1 277)mL,即(1.04±0.22)mL·%TBSA-1·kg-1电解质、胶体+(2 910±187)mL葡萄糖,电解质、胶体比为(1.53±0.31)∶1.00;伤后第2个24 h尿量为(2 299±1 362)mL,每小时尿量为(108±61)mL。1例患者发生肺部感染,7例患者发生真菌感染,无患者发生肠道菌群失调。本组患者抗生素应用时间为21~85(50±16)d,均为2种抗生素联合应用。入院后1个月内无患者死亡,住院时间为53~132(98±44)d,10例患者救治成功。 结论 烧伤外科与重症医学科医师合作救治"八二"昆山工厂铝粉尘爆炸事故群体特重度烧伤患者,患者休克期血流动力学稳定、平稳度过休克期,并发症较少、住院时间较短、入院后1个月无患者死亡、较多患者被救治成功,可为救治群体特重度烧伤患者提供一定的参考。Abstract: Objective To analyze effects of cooperation between physicians in department of burn surgery and department of intensive care medicine on rescue and treatment of severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident. Methods On August 2nd, 2014, 15 extremely severe burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident were admitted to temporary burn treatment center established in Department of Critical Care Medicine of the Second Affiliated Hospital of Soochow University. The 15 patients were equally divided into 3 groups, with 5 patients in each group. Fifteen surgeons and 30 nurses from department of burn surgery and 15 physicians and 30 nurses from department of intensive care medicine from different hospitals in China were divided into 3 groups, with 5 physicians and 10 nurses from department of burn surgery and 5 physicians and 10 nurses from department of intensive care medicine in each group. Each group of physicians and nurses were responsible for treatment of 5 patients. Treatment of patients was leaded by surgeons from department of burn surgery, who were responsible for wound dealing and operation. Physicians from department of intensive care medicine were responsible for systemic treatment and adjustment of relevant equipment's parameters. Volume of fluid infusion and urine output in shock period, severe systemic complication during period of treatment, using time and kind of antibiotics, death in 1 month after admission, length of hospital stay, and survival of patients were monitored. Results Volume of fluid infusion of 15 extremely severe burn patients within the first 24 hours post injury was 10 360-17 162 (12 998±1 811) mL, including (1.62±0.23) mL·% total body surface area (TBSA)-1·kg-1 electrolyte and colloid and (2 850±232) mL glucose, with electrolyte and colloid ratio of (1.76±0.23)∶1.00. Volume of urine output within the first 24 hours post injury was (2 384±1 242) mL, with (99±52) mL in each hour. Volume of fluid infusion of 15 extremely severe burn patients within the second 24 hours post injury was 8 720-11 616 (9 406±1 277) mL, including (1.04±0.22) mL·%TBSA-1·kg-1 electrolyte and colloid and (2 910±187) mL glucose, with electrolyte and colloid ratio of (1.53±0.31)∶1.00. Volume of urine output within the second 24 hours post injury of patients was (2 299±1 362) mL , with (108±61) mL in each hour. One patient had pulmonary infection, and 7 patients had fungal infection, and no patient had gut microbiota dysbiosis. Patients were treated with combined 2 kinds of antibiotics for 21-85 (50±16) d. No patient died within 1 month after admission. The length of hospital stay was 53-132 (98±44) d. Ten patients survived finally. Conclusions After being treated by cooperation between physicians in department of burn surgery and department of intensive care medicine, severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident had hemodynamic stability and could stably experience shock period, with less complication, shorter length of hospital stay, no death within 1 month after admission, more survived patients, which can provide reference for rescue and treatment of severe mass burn patients.
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Key words:
- Burns /
- Accidents /
- Discipline cooperation /
- Mass burns /
- Kunshan explosion
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