老年严重烧伤患者早期脏器损伤特点的回顾性研究

王文盛; 向飞; 宋华培; 张灿; 张兵钱; 吕艳玲; 袁红萍; 胡高中; 黄跃生

doi:10.3760/cma.j.issn.1009-2587.2019.03.002

老年严重烧伤患者早期脏器损伤特点的回顾性研究

doi: 10.3760/cma.j.issn.1009-2587.2019.03.002

1. 陆军军医大学(第三军医大学)第一附属医院全军烧伤研究所,创伤、烧伤与复合伤国家重点实验室,重庆 400038;
2. 陆军军医大学(第三军医大学)第一附属医院整形科,重庆 400038;
3. 重庆医药高等专科学校临床医学院 401331

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出版历程
- 收稿日期: 2018-11-24
- 网络出版日期: 2021-10-28
- 刊出日期: 2019-03-20

Retrospective study on the characteristics of early organ injury in elderly patients with severe burns

1. State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing 400038, China;
2. Department of Plastic Surgery, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing 400038, China;
3. School of Clinical Medicine, Chongqing Medical and Pharmaceutical College, Chongqing 401331, China

摘要

摘要: 目的分析老年严重烧伤患者早期脏器损伤的临床特点及其对预后的影响。方法将陆军军医大学(第三军医大学)第一附属医院全军烧伤研究所(以下称笔者单位)2010年1月—2018年8月收治的符合入选标准的62例入院时年龄≥60岁的严重烧伤患者(男43例、女19例，年龄60～89岁)纳入老年组，将同期124例入院时年龄在18～59岁的严重烧伤患者(男86例、女38例，年龄18～59岁)纳入中青年组。2组患者入院后均按笔者单位常规治疗方案治疗。回顾性分析2组患者如下指标。(1)伤后第1、2个24 h的补液量和尿量，入院时及伤后24、48 h的血红蛋白、血细胞比容、血乳酸水平。(2)入院时、休克期、伤后3～7 d的心肌型肌酸激酶同工酶(CK－MB)、总胆红素、血肌酐、氧合指数、血小板计数。(3)病重病危天数及死亡情况。对数据行χ²检验、成组t检验、Mann－Whitney U检验、重复测量方差分析及Bonferroni校正。结果 (1)2组患者伤后第1、2个24 h补液量及伤后第2个24 h尿量比较，差异无统计学意义(t＝0.351、1.307，1.110，P>0.05)；老年组患者伤后第1个24 h尿量明显少于中青年组(t＝5.628，P<0.05)。2组患者入院时及伤后24、48 h血红蛋白(t＝0.011、1.075、0.239)、血细胞比容(t＝0、0.033、0.199)及血乳酸水平(t＝0.017、1.002、0.739)比较，差异无统计学意义(P>0.05)。(2)2组患者入院时及伤后3～7 d CK－MB水平比较，差异无统计学意义(t＝0.069、0.001，P>0.05)；老年组患者休克期CK－MB水平明显高于中青年组(t＝4.017，P<0.05)。2组患者入院时及伤后3～7 d总胆红素水平比较，差异无统计学意义(t＝0.227、0.002，P>0.05)；老年组患者休克期总胆红素水平明显高于中青年组(t＝6.485，P<0.05)。老年组患者入院时及休克期血肌酐水平明显高于中青年组(t＝4.226、12.299，P<0.05或P<0.01)；2组患者伤后3～7 d血肌酐水平比较，差异无统计学意义(t＝0.693，P>0.05)。老年组患者入院时、休克期及伤后3～7 d氧合指数分别为(371±16)、(263±16)、(228±18)mmHg(1 mmHg＝0.133 kPa)，明显低于中青年组的(420±13)、(327±13)、(281±17)mmHg(t＝5.650、9.782、4.856，P<0.05或P<0.01)。2组患者入院时及休克期血小板计数比较，差异无统计学意义(t＝0.038、0.588，P>0.05)；老年组患者伤后3～7 d血小板计数明显低于中青年组(t＝6.636，P<0.05)。(3)老年组患者的病重病危天数、病死率分别长于、高于中青年组(Z＝－2.303，χ²＝13.676，P<0.05或P<0.01)。结论与中青年严重烧伤患者相比，在休克期同等组织灌注的情况下，老年严重烧伤患者早期心脏、肝脏、肾脏、肺脏、凝血系统损伤明显，病情重且病死率高。
- 烧伤 /
- 老年人 /
- 死亡率 /
- 脏器损伤
Abstract: Objective To analyze the clinical characteristics of early organ injury in elderly patients with severe burns and the effects on the prognosis of patients. Methods From January 2010 to August 2018, 62 patients with severe burns (43 men and 19 women, aged from 60 to 89 years at the time of admission) who were hospitalized in the Institute of Burn Research of the First Affiliated Hospital of Army Medical University (the Third Military Medical University, hereinafter referred to as the author′s affiliation), meeting the inclusion criteria, were included in elderly (E) group, and 124 patients with severe burns (86 men and 38 women, aged from 18 to 59 years at the time of admission) at the same term were included in young and middle-aged (YM) group. Treatment of patients in the 2 groups followed the conventional procedures of the author′s affiliation. The following data of patients in the 2 groups were retrospectively analyzed. (1) Fluid replacement volume and urine volume within the first and second post injury hour (PIH) 24 were recorded. The levels of hemoglobin, haematocrit, and blood lactic acid at admission, PIH 24 and 48 were recorded. (2) The creatine kinase isozyme-MB (CK-MB), total bilirubin, blood creatinine, oxygenation index, and blood platelet count at admission, at shock stage, and on post injury day (PID) 3 to 7 were collected. (3) The days of seriously or critically ill and deaths were recorded. Data were processed with chi-square test, group t test, Mann-Whitney U test, analysis of variance for repeated measurement, and Bonferroni correction. Results (1) There were no statistically significant differences in fluid replacement volume within the first and second PIH 24, and urine volume within the second PIH 24 between patients in the 2 groups (t=0.351, 1.307, 1.110, P>0.05). The urine volume of patients in group E within the first PIH 24 was significantly less than that in group YM (t=5.628, P<0.05). There were no statistically significant differences in levels of hemoglobin (t=0.011, 1.075, 0.239), haematocrit (t=0, 0.033, 0.199), and blood lactic acid (t=0.017, 1.002, 0.739) at admission, PIH 24 and 48 between patients in the 2 groups (P>0.05). (2) There were no statistically significant differences in levels of CK-MB at admission and on PID 3 to 7 between patients in the 2 groups (t=0.069, 0.001, P>0.05). The level of CK-MB of patients in group E at shock stage was significantly higher than that in group YM (t=4.017, P<0.05). There were no statistically significant differences in levels of total bilirubin at admission and on PID 3 to 7 between patients in the 2 groups (t=0.227, 0.002, P>0.05). However, the level of total bilirubin of patients in group E at shock stage was significantly higher than that in group YM (t=6.485, P<0.05). The levels of blood creatinine of patients in group E at admission and shock stage were significantly higher than those in group YM (t=4.226, 12.299, P<0.05 or P<0.01), while there was no statistically significant difference between them on PID 3 to 7 (t=0.693, P>0.05). The oxygenation indexes of patients in group E at admission and shock stage and on PID 3 to 7 [(371±16), (263±16), and (228±18) mmHg (1 mmHg=0.133 kPa)] were lower than (420±13), (327±13), and (281±17) mmHg of patients in group YM, respectively (t=5.650, 9.782, 4.856, P<0.05 or P<0.01). There were no statistically significant differences in levels of blood platelet count at admission and shock stage between patients in the 2 groups (t=0.038, 0.588, P>0.05), while the level of blood platelet count of patients in group E on PID 3 to 7 was significantly lower than that in group YM (t=6.636, P<0.05). (3) The days of seriously or critically ill and death rate of patients in group E were respectively longer or higher than those in group YM (Z=-2.303, χ²=13.676, P<0.05 or P<0.01). Conclusions In the case of the same tissue perfusion at shock stage, injuries in heart, liver, kidney, lung, and coagulation system in elderly patients with severe burns are more obvious than those in young and middle-aged patients, with more severe illness and higher mortality.
- Burns /
- Aged /
- Mortality /
- Organ injury