Analysis of the misdiagnosis causes and treatment strategies for burns combined with alcohol withdrawal syndrome
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摘要:
目的 探讨烧伤合并酒精戒断综合征（AWS）的误诊原因及处理策略。 方法 该研究为回顾性观察性研究。2014年1月—2023年12月，解放军联勤保障部队第990医院全军烧伤中心收治334例符合入选标准的烧伤合并酒精依赖的患者，均为男性，年龄29~90（53±11）岁。将患者按是否发生AWS分为AWS组（29例）与无AWS组（305例），统计AWS组患者AWS误诊原因及治疗结果，比较2组患者的烧伤总面积、Ⅲ度烧伤面积、烧伤指数、住院天数及病死率。将334例患者按烧伤严重程度分为轻中度烧伤患者（306例）、重度烧伤患者（11例）、特重度烧伤患者（17例），分析烧伤合并酒精依赖的患者AWS发生率与烧伤严重程度之间的相关性。 结果 AWS组患者AWS误诊的主要原因是医师对AWS认知不足，占48.3%（14/29）；其次是烧伤合并症（休克、电解质紊乱、应激性精神障碍、癫痫）症状与AWS的症状相似，影响了医师的正确判断，占51.7%（15/29）。经积极治疗后，27例患者AWS症状明显缓解或消失，2例患者因多器官功能衰竭死亡。与无AWS组比较，AWS组患者烧伤总面积、Ⅲ度烧伤面积和烧伤指数均显著增大（Z值分别为-8.35、-6.98、-8.32，P < 0.05），住院天数明显增多（Z=-4.56，P < 0.05）。AWS组患者病死率为6.9%（2/29），明显高于无AWS组的0.7%（2/305），P < 0.05。轻中度、重度、特重度烧伤患者AWS发生比例分别为4/306、8/11、17/17，烧伤合并酒精依赖的患者AWS发生率与烧伤严重程度呈显著正相关（r=0.87，P < 0.05）。 结论 烧伤患者AWS的发生率低，其发生和烧伤的严重程度密切相关，以酒龄较长的40岁以上的严重烧伤男性患者为主，AWS症状出现较晚且易被烧伤合并症的症状所掩盖，故容易误诊甚至漏诊。因此临床医师应加强对40岁以上的严重烧伤男性患者的饮酒史筛查，及时请相关学科医师会诊，争取早诊断、早处理，以降低误诊、漏诊风险并改善预后。 Abstract:Objective To investigate the misdiagnosis causes and treatment strategies for burns combined with alcohol withdrawal syndrome (AWS). Methods This study was a retrospective observational study. From January 2014 to December 2023, 334 male burn patients aged 29-90 (53±11) years and combined with alcohol dependence were admitted to the PLA Burn Center of the 990th Hospital of Joint Logistics Support Force. Patients were divided into AWS group (29 cases) and non-AWS group (305 cases) based on whether AWS developed or not. The misdiagnosis causes and treatment outcomes of AWS of patients in AWS group were analyzed. The total burn surface area, full-thickness burn area, burn index, hospitalization day, and mortality were compared between patients in the two groups. The 334 patients were further stratified by burn severity into mild-moderate burn patients (306 cases), severe burn patients (11 cases), and critically severe burn patients (17 cases), and the correlation between AWS incidence and burn severity in patients with burns combined with alcohol dependence was analyzed. Results The misdiagnosis causes of AWS in AWS group of patients were primarily insufficient clinician awareness of AWS (48.3%, 14/29) and then overlapping symptoms between AWS and burn-related complications, such as shock, electrolyte imbalance, stress-induced mental disorders, and epilepsy (51.7%, 15/29), which influenced judgement of the clinicians. After active treatment, the AWS symptoms alleviated obviously or disappeared in 27 patients, while 2 patients died of multiple organ failure. Compared with those in non-AWS group, the total burn surface area, full-thickness burn area, burn index, and hospitalization day of patients in AWS group were significantly increased (with Z values of -8.35, -6.98, -8.32, and -4.56, respectively, P < 0.05). The mortality of patients in AWS group was 6.9% (2/29), which was significantly higher than 0.7% (2/305) in non-AWS group (P < 0.05). The AWS incidences of patients with mild-moderate burn, severe burn, and critically severe burn were 4/306, 8/11, and 17/17, respectively, and the AWS incidences of burn patients combined with alcohol dependence had strongly positive correlation with burn severity (r=0.87, P < 0.05). Conclusions The AWS incidence in burn patients is low, and its incidence is closely correlated with burn severity, predominantly affecting males over 40 years old with prolonged alcohol use and severe burns. The AWS symptoms appear later and are easily masked by symptoms of burn complications, making it easy to misdiagnose or even miss the diagnosis. Therefore, clinicians should strengthen the screening of alcohol drinking history in male severe burn patients over 40 years old, and consult with physicians of relevant disciplines in a timely manner to ensure early diagnosis and intervention to reduce the risks of misdiagnosis or missed diagnosis and to improve prognosis. -
Key words:
- Alcohol abstinence /
- Burns /
- Diagnostic errors /
- Alcohol use disorder /
- Treatment strategies
本文亮点(1) 揭示了烧伤严重程度与酒精戒断综合征（AWS）的发生率呈显著正相关，严重烧伤合并酒精依赖患者发生AWS风险极高，应引起临床医师的高度重视。(2) 提出应提高临床医师对烧伤后AWS的认知，强调对患者病史的询问，特别是对40岁以上严重烧伤男性患者的饮酒史筛查是防止AWS误诊、漏诊的重要措施，多学科团队协作是明确诊断AWS的必要策略。 -
参考文献
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表 1 2组烧伤合并酒精依赖患者一般资料比较（x ± s）
Table 1. Comparison of general data between two groups of burn patients combined with alcohol dependence
组别 例数 年龄（岁） 饮酒史（年） 伤后入院时间（h） AWS组 29 55±12 19±4 7.6±2.1 无AWS组 305 53±11 17±7 7.5±2.9 t值 -0.95 -1.65 -0.20 P值 0.342 0.099 0.839 注：AWS为酒精戒断综合征 
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表 2 2组烧伤合并酒精依赖患者烧伤严重程度与临床治疗情况比较
Table 2. Comparison of burn severity and clinical treatment outcomes between two groups of burn patients combined with alcohol dependence
组别 例数 烧伤总面积[%TBSA，M（Q1，Q3）] Ⅲ度烧伤面积[%TBSA，M（Q1，Q3）] 烧伤指数[%TBSA，M（Q1，Q3）] 住院天数[d，M（Q1，Q3）] 病死情况[例（%）] AWS组 29 55（40，85） 25（6，64） 45.0（25.0，74.5） 53.0（24.5，86.5） 2（6.9） 无AWS组 305 7（4，15） 5（1，12） 5.0（2.3，9.0） 16.0（9.0，31.0） 2（0.7） Z值 -8.35 -6.98 -8.32 -4.56 — P值 < 0.001 < 0.001 < 0.001 < 0.001 0.039 注：AWS为酒精戒断综合征，TBSA为体表总面积；“—”表示无此项
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