摘要
目的回顾性分析西峡县"5·17"爆炸烧伤特点与救治,探讨特大爆炸事故的救治策略。方法以西峡县"5·17"爆炸事故中,南阳烧伤创伤医疗中心接诊的13例严重爆炸烧伤患者为对象,详细记录患者性别、年龄、烧伤面积、烧伤深度,烧伤合并伤及并发症、呼吸功能维持、休克期复苏补液、休克期后切痂微粒皮肤移植等信息,分析器官功能支持及90d综合治疗效果。结果依靠区域创伤医疗中心的辐射带动作用,及时完成了伤员的紧急救援期三级救治是西峡县特大爆炸事故救治工作的主要模式,其中一、二级救治是关键环节。三级救治模式包括:事故当地医院为一级急救医疗机构,县医院为二级急救医疗机构,其他上级医疗机构为三级急救医疗机构。各级医疗机构接到救援报告后,立即启动院前和院内急救流程,组建烧伤创伤综合救治团队,包括:烧伤外科、急诊科、普通外科、骨科、胸外科、神经外科、整形外科、重症医学科、输血科、麻醉科、介入放射学专业等相关学科。13例烧伤患者均为男性,合并吸入性损伤、爆震伤、血气胸、颅脑损伤、骨折等,其中8例(61.54%)出现多器官障功能碍综合征(MODS),主要累及呼吸、循环、肝脏、胃肠道、肾脏及凝血功能。通过多学科协作救治,6例重度烧伤患者经保持气道通畅、复苏补液及清创换药等综合治疗,创面愈合痊愈出院;7例大面积深度烧伤患者中,1例颅底骨折并颅脑开放性损伤、广泛颅内出血、血气胸,于9h后死亡;1例早期切开减张处渗出明显,于伤后24h内死亡;余5例休克期平稳度过后第4天起开始切痂微粒皮+同种异体皮移植,1周后进行第2轮微粒皮肤移植手术,但均合并脓毒症或真菌性感染而死亡。结论西峡县特大爆炸中大面积深度烧伤患者病程中多出现MODS和感染,多学科协作救治可增加其生存并降低伤残程度。
Objective To retrospectively analyze the injury characteristics of victims and treatment strategies in the explosion accident on the 17th May 2018 in Xixia county(Xixia "May 17th" explosion accident).Methods Based on the practice featured in pre-hospital emergency of Henan province and Nanyang city Emergency Center in the explosion accident,a retrospective analysis for the Level Three medical rescue was conducted,where a total of thirteen survived victims in Xixia "May 17" explosion accident were studied retrospectively.The data included the gender,age,burned extent and depth of the patients,burns complicated by trauma,complication of burn,respiratory function maintenance,resuscitation during shock stage,skin grafting with excision and scab.Furthermore,the data of organ function and the effect of the 90-day comprehensive treatment for the burned victims wereanalyzed.Results completion the Level Three treatment on time,which was depended on the leading role played by the regional trauma centers was the main rescuing mode of the work in Xixia county,where the primary and secondary treatments were the key parts.The three-level treatment model includes:the local hospital acts as a level-one emergency medical institution,county hospitals function as secondary emergency medical institutions,and other higher medical institutions are the tertiary first aid medical institutions.The pre-hospital and in-hospital emergency procedures were initiated immediately after the large-scale explosive burn being identified,the key to the successfully rescue was to set up a comprehensive treatment team for burns and trauma.Rescue team should involve burn department and other related departments,including the departments of emergency,general surgery,orthopedic,thoracic surgery,neurosurgery,plastic surgery,intensive care unit,blood transfusion unit,anesthesiology,and interventional radiology,etc.All the thirteen burned patients were male,with inhalation injury,blast injury,hemopneumothorax,brain injury,bone fractures,and etc.Eight of them(61.54%)had multiple organ dysfunction syndrome(MODS).MODS mainly involved respiratory,circulatory,liver,gastrointestinal tract,kidney and coagulation function.With the multi-discipline treatment,the wound of 6 severely-burned patients started healing and can be discharged after keeping the patency of airway,applying resuscitation fluid and comprehensive treatments such as debridement and dressing change.Among 7 patients with extensive deep burns,one case with skull-based fracture,open craniocerebral,extensive intracranial hemorrhage and hemopneumothorax,died 9 hours later.Another case died within 24 hours after injury due to obvious exudation on the site of early incision and relaxation of wound.The escharotomy,micro-dermis and allograft skin transplantation were carried out for five cases with extensive deep burns from the 4th day after the recovery of shock.One week later,the second stage of microsphere skin transplantation was performed.But all died of sepsis or fungal infection.Conclusions MODS and infection often occur during the course especially for patients with extensive and deep burns due to the great explosion in Xixia county,most of whom were accompanied with MODS and infection.Therefore,assembling multi-discipline team for treating the group of explosively-burned patients can increase the survival rate and reduce the possibility of disability.
作者
王硕
杨丙厚
李翔
孙羽飞
曹书广
祝天华
徐闽军
李雪银
李天宇
赵俊祥
Wang Shuo;Yang Binghou;Li Xiang;Sun Yufei;Cao Shuguang;Zhu Tianhua;Xu Minjun;Li Xueyin;Li Tianyu;Zhao Junxiang(Department of Burns and Plastic Surgery,the Affiliated Nanshi Hospital of Henan University,Nanyang 473065,Henan, China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2018年第12期1196-1199,共4页
Chinese Critical Care Medicine
基金
“十二五”国家临床重点专科建设项目(2018-292)
河南省医学重点(培育)学科建设项目(2011-25).
关键词
爆炸事故
区域创伤医疗中心
感染
Explosion accidents
Regional trauma center
Infection
作者简介
通讯作者:王硕,Email:wwy210398@sina.com
