电动车起火致成批烧伤病例的临床回顾性分析

发布时间：2018-01-28 04:04

本文关键词： 电动车起火成批烧伤吸入性损伤　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景烧伤主要指热力、化学物质、电能、放射线等引起的皮肤、黏膜甚至深部组织的损害,其中以热力烧伤(如热水、火焰等)最为多见[1]。我国烧伤医学经过50多年的风雨历程和几代人的努力,无论在临床诊治水平还是基础理论研究方面都取得了令人瞩目的的巨大成就,多年来,烧伤总治愈率,特别是严重大面积烧伤治愈率一直遥居世界前列,在历年重大灾难性事件中发挥了巨大作用。近年来,随着社会经济建设的快速发展,因工业化时代高能损伤造成成批烧伤事件不断发生,因成批烧伤患者具有突发性强、相对集中、数量多、伤情复杂等特点,使得患者救治难度大,成批烧伤事故发生后,不仅给伤员和事故单位带来了巨大损失,也造成了巨大的社会影响。目的1、回顾性分析南宁市近两年电动车起火致成批烧伤患者的临床病例资料,探讨成批烧伤患者的发病特点、影响其预后的相关因素,总结治疗经验,为进一步提高成批烧伤的治愈率提供临床参考依据。2、为制定南宁市今后成批烧伤患者的诊治流程提供参考依据。方法收集2015年1月1日至2016年12月31日南宁市电动车起火致成批烧伤病人的病历资料,排除因个人原因未治疗者。统计起火原因、时间、地点及人数,每个病人的性别、年龄、烧伤总面积(%TBSA)、Ⅲ度烧伤面积、吸入性损伤、机械通气、纤支镜应用情况、复合伤、休克、感染及内脏并发症的发生情况及预后情况,总结治疗经验。结果1、在17批173例病例中,14批发生在夜间,3批发生在白天;14批发生在室内,3批发生在室外;10批电动车起火的原因是充电时间过长;门诊治疗108人,住院治疗65人;20-49岁年龄段的患者发病率高,占患者总数的61.62%;烧伤程度以轻中度为主,占所有病例73.58%,合并肺部爆震伤3例,软组织伤10例,骨折2例,颅脑损伤1例,2、吸入性损伤的程度:轻度63例(52.94%),中度39例(32.77%),重度17例(14.29%),以轻中度为主。3、本组患者共死亡9例,病死率为5.20%,其中男5例,女4例。死亡主要死亡原因:吸入性损伤7例(77.78%),重度颅脑损伤1例(11.11%),复合伤合并大面积烧伤1例(11.11%)。4、吸入性损伤及严重程度、机械通气、纤维支气管镜应用与患者预后相关,吸入性损伤是影响成批烧伤患者预后的主要独立危险因素。结论1、电动车起火致成批烧伤事故主要发生在夜间、室内,不容易发现,直至烟雾吸入后发现。2、本批患者在密闭空间环境导致吸入性损伤,以烟雾吸入性损伤为主,比普通常见皮肤烧伤治疗难度大;皮肤烧伤较轻,小于10%体表烧伤面积的患者占69.94%。3、影响电动车起火致成批烧伤患者预后的主要因素是吸入性损伤,吸入性损伤患者行气道灌洗(纤支镜清理)后可明显降低死亡率。
[Abstract]:Background Burn mainly refers to the damage of skin, mucous membrane and even deep tissue caused by heat, chemical, electric energy, radiation and so on, among which thermal burns (such as hot water, flame, etc.) are the most common. [1. Burn medicine in China has made great achievements in clinical diagnosis and treatment and basic theory research after more than 50 years of hard work. The total cure rate of burn, especially the cure rate of severe large area burn, has always been in the forefront of the world, and has played a great role in the major and disastrous events of the past years. In recent years, with the rapid development of social and economic construction. Because of the industrial era high energy injury caused by the batch of burn events continue to occur, because of the group of burn patients with sudden strong, relatively concentrated, the number of injuries, complex injuries and other characteristics, so that the treatment of patients is very difficult. After mass burn accidents, not only the injured and accident units have brought huge losses, but also caused a huge social impact. Objective 1. The clinical data of burn patients caused by electric vehicle fire in Nanning in recent two years were analyzed retrospectively. To provide clinical reference for further improving the cure rate of burn in batches. 2. Methods from January 1st 2015 to December 31st 2016, the medical records of burn patients caused by electric vehicle fire in Nanning City were collected. Material. The patients who were not treated for personal reasons were excluded. The cause, time, location and number of the fire were counted, the sex, age, total area of burn, area of third degree burn, inhalation injury, mechanical ventilation of each patient were calculated. The application of fiberoptic bronchoscopy, compound injury, shock, infection, visceral complications and prognosis were summarized. Results 1. In 17 groups of 173 cases, 14 cases occurred at night. 3 batches occurred during the day; 14 batches occurred in indoor and 3 batches outside. 10 batches of electric vehicles caught fire because the charging time is too long; 108 outpatients and 65 inpatients; The incidence rate of patients aged 20-49 years was high, accounting for 61.62% of the total number of patients. The degree of burn was mainly mild and moderate, accounting for 73.58% of all cases, including 3 cases of lung blast injury, 10 cases of soft tissue injury, 2 cases of fracture and 1 case of craniocerebral injury. The degree of inhalation injury: mild 63 cases (52.94g), moderate 39 cases (32.77), severe 17 cases (14.29%), mild to moderate (3 cases). 9 cases died in this group. The mortality rate was 5.20%, including 5 males and 4 females. The main causes of death were as follows: inhalation injury in 7 cases, severe craniocerebral injury in 1 case, and severe craniocerebral injury in 1 case. One case of compound injury complicated with large area burn was 11.11%. The degree of inhalation injury, mechanical ventilation and fiberoptic bronchoscopy were related to the prognosis of the patients. Inhalation injury is the main independent risk factor affecting the prognosis of burn patients. Conclusion 1. Mass burn accidents caused by electric vehicle fire mainly occur at night and are not easily found indoors. Until the smoke inhalation found. 2, this group of patients in the closed space environment resulting in inhalation injury, mainly smoke inhalation injury, than ordinary common skin burn treatment is more difficult; The number of patients with skin burn less than 10% was 69.94.3. the main factor affecting the prognosis of burn patients caused by electric vehicle fire was inhalation injury. Airway lavage (fiberoptic bronchoscopy) can significantly reduce mortality in patients with inhalation injury.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R644

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