背景:大面积烧伤的治疗和管理,定义为影响≥50%的全身表面积(TBSA)的烧伤自90年代以来发生了很大变化。这项研究旨在分析重症监护病房(ICU)的住院时间,在过去的18年中,植皮手术的成功和死亡率发生了变化。
方法:在2000年至2018年之间,有77例因大面积烧伤而被送往大学医院的ICU。转移和早期护理退出排除了38名患者的纳入,留下39个分析。研究变量是入院年份,人口统计,燃烧特性,重症监护治疗(液体复苏,通气和营养)和手术治疗。通过相关性和逻辑回归分析评估结果与入院年份之间的相关性。通过逐步线性回归评估潜在的混杂因素。
结果:患者特征随着时间的推移是稳定的,中位年龄为36[25.0,48.0]岁,烧伤65%[55.0,83.0]TBSA,深度烧伤55%[50.0,68.0]TBSA。ICU停留时间稳定在0.97[0.6,1.5]天/%TBSA。死亡率也是稳定的。能量和碳水化合物输送与每位患者的感染发作次数平行减少。手术次数稳定,但植皮率明显增加。多变量分析保留了入院年份,体重,感染总数,每日脂质摄入量和液体复苏作为独立预测变量。
结论:ICU住院时间和死亡率没有随时间变化,但植皮率显著提高。
BACKGROUND: The treatment and management of massive burns, defined as burns affecting≥ 50% of total body surface area (TBSA) has considerably changed since the 90s. This study aimed at analyzing if the length of intensive care unit (ICU) stay, the success of skin grafting operations and the mortality changed in the last 18 years.
METHODS: Between 2000 and 2018, 77 patients were admitted for massive burns to the ICU of a university hospital. Transfers and early care withdrawal precluded inclusion for 38 patients, leaving 39 for analysis. Study variables were year of admission, demographics, burn characteristics, critical care treatment (fluid resuscitation, ventilation and nutrition) and surgical therapy. Association between outcomes and year of admission were assessed through correlation and logistic regression analysis. Potential confounders were assessed through stepwise linear regression.
RESULTS: Patients\' characteristics were stable over time with a median age of 36[25.0, 48.0] years, burns 65% [55.0, 83.0] TBSA and deep burns 55% [50.0, 68.0] TBSA . Length of ICU stay remained stable at 0.97 [0.6, 1.5] days/%TBSA. Mortality was stable as well. Energy and carbohydrate delivery decreased in parallel with the number of infectious episodes per patient. Number of operations was stable but the take rate of skin grafts increased significantly. The multivariate analysis retained year of admission, weight, total number of infections, daily lipid intakes and fluid resuscitation as independent predicting variables.
CONCLUSIONS: Length of ICU stay and mortality did not change over time but skin grafts take rates improved significantly.