多学科团队诊疗模式在烧伤复合热射病患者救治中的应用

蒋莎莎; 王楠楠; 王欢欢; 肖荣; 张森林; 王超; 闫进; 胡东升; 段森凌; 林之琛; 胡明远; 李嵩; 王明; 吕娜; 吉云亮; 冯奇; 李庆华; 林国安; 闫甜甜

doi:10.3760/cma.j.cn501225-20250729-00330

多学科团队诊疗模式在烧伤复合热射病患者救治中的应用

doi: 10.3760/cma.j.cn501225-20250729-00330

1.
解放军联勤保障部队第九九〇医院心胸外科,驻马店　463000
2.
解放军联勤保障部队第九九〇医院全军烧伤中心,驻马店　463000

基金项目:

河南省医学科技攻关计划项目 LHGJ20210830

驻马店市科技创新青年专项项目 QNZX202411

解放军联勤保障部队第九九〇医院院内课题重点项目 21ZDXM01

详细信息

通讯作者:
闫甜甜,Email：tiantianyan27031@163.com

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出版历程
- 收稿日期: 2025-07-29

Application of multidisciplinary team diagnosis and treatment model in the management of patients with combined burns and heat stroke

1.
Department of Cardiothoracic Surgery, the 990th Hospital of PLA Joint Logistic Support Force, Zhumadian 463000, China
2.
Military Burn Center, the 990th Hospital of PLA Joint Logistic Support Force, Zhumadian 463000, China

Funds:

Henan Provincial Medical Science and Technology Research Plan Project LHGJ20210830

Zhumadian City Science and Technology Innovation Youth Special Project QNZX202411

Key Project of the 990th Hospital of Joint Logistic Support Force 21ZDXM01

More Information

Corresponding author: Yan Tiantian, Email: tiantianyan27031@163.com

摘要

摘要: 目的探讨多学科团队（MDT）诊疗模式在烧伤复合热射病患者救治中的应用。方法该研究为回顾性观察性研究。2022年1月—2024年12月,解放军联勤保障部队第九九〇医院全军烧伤中心收治5例、重症医学科收治4例符合入选标准的烧伤复合热射病患者,均为男性,年龄64~78（70±5）岁。患者发病月份集中于6—9月,时间段集中于10：00—14：30,环境温度>30 ℃,湿度≥60%。在MDT诊疗模式下,由全军烧伤中心主任担任组长,联合重症医学科、肾内科、呼吸内科、心内科、神经内科、麻醉科、内分泌科、药剂科、康复科、营养科及输血科团队组成固定MDT,通过明确分工、标准化信息沟通及每日跨学科交班,实现诊疗过程的统筹协调与决策执行一体化。统计患者的烧伤相关特征,包括烧伤总面积、烧伤指数、合并吸入性损伤情况；治疗情况,包括入院后第1个24 h输液率、入院后第2个24 h输液率、入院后48 h内输液率、血液制品使用情况、行连续性血液净化（CBP）治疗情况、行有创机械通气情况、首次手术时间；预后情况,包括住重症监护病房（ICU）时长、总住院时长、入院7 d内的病死情况。结果患者烧伤总面积为22.6%（10.5%,23.0%）体表总面积,烧伤指数为12.5（8.0,13.5）,合并吸入性损伤者5例。7例患者入院后第1个24 h输液率、第2个24 h输液率、48 h内输液率均明显高于预计输液率（t值分别为4.39、8.58、3.69,P<0.05）。6例患者使用了血液制品。3例患者行CBP治疗,平均上机时长64.7 h；4例患者行有创机械通气,平均上机时长60.0 h。5例患者接受手术治疗,首次手术时间为入院后13~19[16.0（13.7,19.0）]d。患者住ICU时长0~504[216（18,252）]h,总住院时长0.5~71.0[11.0（1.4,46.5）]d。4例患者在入院7 d内死亡。结论烧伤复合热射病患者具有烧伤面积相对有限,常伴有吸入性损伤,补液量大等特点,面临需要多种方式器官功能支持、手术时机延迟等临床挑战。在此背景下,以烧伤科和重症医学科为核心的MDT诊疗模式,为统筹复杂的复苏管理、器官功能支持与手术时机决策提供了合理路径。
- 烧伤 /
- 多器官功能衰竭 /
- 补液疗法 /
- 热射病 /
- 多学科团队 /
- 危重症 /
- 创面修复
Abstract: Objective To explore the application of multidisciplinary team (MDT) diagnosis and treatment model in the management of patients with combined burns and heat stroke. Methods This study was a retrospective observational study. From January 2022 to December 2024, the Military Burn Center admitted 5 patients and the Department of Critical Care Medicine of the 990^th Hospital of PLA Joint Logistic Support Force admitted 4 patients with combined burns and heat stroke that met the inclusion criteria. All patients were male, aged 64-78 (70±5) years. The onset of the disease in patients occurred mainly during June to September, with the time frame predominantly between 10:00 and 14:30, in environment with temperature>30 ℃ and humidity≥60%. Under the MDT diagnosis and treatment model, a fixed MDT was established with the director of the Military Burn Center as the leader, which included specialists from critical care medicine, nephrology, respiratory medicine, cardiology, neurology, anesthesiology, endocrinology, pharmacy, rehabilitation, nutrition, and transfusion medicine. Through clear division of responsibilities, standardized information communication, and daily interdisciplinary handovers, integrated coordination and decision-making in the diagnosis and treatment process were achieved. The burn-related characteristics including total burn area, burn index, and combination of inhalation injury, treatment including infusion rate in the first 24 h post admission, infusion rate in the second 24 h post admission, and total infusion rate within 48 h post admission, use of blood products, status of continuous blood purification (CBP) treatment, administration of invasive mechanical ventilation, and timing of the first surgery, outcomes including length of intensive care unit (ICU) stay, total hospital stay, and mortality within 7 days after admission of patients were recorded. Results The total burn area of patients was 22.6% (10.5%, 23.0%) total body surface area, the burn index was 12.5 (8.0, 13.5), and 5 patients were combined with inhalation injury. The infusion rate in the first 24 h post admission, infusion rate in the second 24 h post admission, and total infusion rate within 48 h post admission of 7 patients were significantly higher than the planned fluid infusion rates (with t values of 4.39, 8.58, and 3.69, respectively, P<0.05). Blood products were used in 6 patients. CBP was performed in 3 patients with an average duration of 64.7 h, and invasive mechanical ventilation was applied in 4 patients with an average duration of 60.0 h. Five patients underwent surgery, with the first surgery performed at 13-19 (16.0 (13.7, 19.0)) days post admission. The patients' length of ICU stay was 0-504 (216 (18, 252)) h, and the total hospital stay was 0.5-71.0 (11.0 (1.4, 46.5)) d. Four patients died within 7 days after admission. Conclusions Patients with combined burns and heat stroke are characterized by relatively limited burn area, frequent inhalation injury, and large volume of fluid resuscitation, thus facing clinical challenges such as the need for multiple ways of organ support and delayed surgical timing. In this context, the MDT diagnosis and treatment model centered on the department of burns and department of critical care medicine provides a rational pathway for coordinating complex resuscitation management, organ function support, and decisions on the timing of surgery.
- Burns /
- Multiple organ failure /
- Fluid therapy /
- Heat stroke /
- Multidisciplinary team /
- Critical illness /
- Wound repair
蒋莎莎：提出研究主题,设计研究框架,采集数据,起草并修改文章；王楠楠、王欢欢、肖荣、张森林、王超、闫进、胡东升、段森凌：采集、分析数据,指导写作；林之琛、胡明远、李嵩、王明、吕娜、吉云亮：分析、解释数据,冯奇、李庆华、林国安：指导研究,对文章内容进行批判性审阅；闫甜甜：指导研究,论文审阅及修改,经费支持

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下载: 全尺寸图片幻灯片

图 1 烧伤复合热射病患者入院时CT结果及后续创面处理情况。1A、1B、1C、1D.分别为头臂干动脉起始处层面、主动脉弓下缘层面、肺动脉干层面、两下肺支气管近段层面CT结果,均可见渗出和胸腔积液；1E.第1次手术前双下肢创面基底苍白；1F.第1次手术清创去除坏死组织后；1G.第2次手术拆除负压封闭引流材料并清创后,创面肉芽组织生长良好；1H.皮片移植术后14 d,皮片存活良好,创面基本愈合

注：图1E~1H中左侧图指示双下肢前侧,右侧图指示双下肢后侧

下载: 全尺寸图片幻灯片