氢氟酸(HF)是一种强腐蚀性,剧毒,和高度危险的无机酸。由无水HF引起的全身表面积(TBSA)超过1%的烧伤可导致深部组织损伤,低钙血症,中毒,甚至死亡。近年来,HF已成为引起化学烧伤的最常见物质之一,并成为化学烧伤死亡的主要原因。在这里,我们报告了一例罕见病例,由35%HF引起的91%TBSA烧伤。病人出现了休克等并发症,严重的低钙血症,代谢性酸中毒,和呼吸衰竭。多学科团队咨询(烧伤,呼吸医学,肾脏病学,传染病,和药房)在入院后立即进行。为患者制定了个性化的诊断和治疗计划。病人接受了重症监护,血容量监测,气管切开术,液体复苏,连续性血液净化,抗感染和镇痛治疗,静脉和经皮补充钙,早期康复训练,心理康复和其他治疗。为了防止伤口加深,损伤后早期进行大面积清创和植皮。将大剂量的10%葡萄糖酸钙分剂量注射到患者体内,用湿敷料连续处理伤口。多次手术清创术,负压伤口治疗,生物敷料,进行Meek植皮。大部分伤口(约85%TBSA)愈合后,患者已出院,并继续在当地医院进行换药。患者出院后3个月随访。所有的伤口愈合良好,患者在日常生活中基本恢复了功能独立。
Hydrofluoric acid (HF) is a strongly corrosive, highly toxic, and highly dangerous mineral acid. Burns with over 1% total body surface area (TBSA) caused by anhydrous HF can lead to deep tissue damage,
hypocalcaemia, poisoning, even death. In recent years, HF has become one of the most common substances causing chemical burns and ranks as the leading cause of death from chemical burns. Herein, we report a rare case with 91% TBSA burns caused by 35% HF. The patient developed complications such as shock, severe
hypocalcaemia, metabolic acidosis, and respiratory failure. Multidisciplinary team consultation (burns, respiratory medicine, nephrology, infectious disease, and pharmacy) was performed immediately after admission. An individualized diagnosis and treatment plan was developed for the patient. The patient was given intensive care, blood volume monitoring, tracheotomy, fluid resuscitation, continuous blood purification, anti-infective and analgesic treatments, intravenous and percutaneous calcium supplementation, early rehabilitation training, psychological rehabilitation and other treatments. To prevent the wound from deepening, large-area debridement and skin grafting were performed early after injury. A large dose of 10% calcium gluconate was injected into the patient in divided doses, and the wound was continuously treated with wet dressings. Multiple surgical debridements, negative pressure wound treatment, biological dressings, and Meek skin grafting were performed. After most of the wounds (approximately 85% TBSA) healed, the patient was discharged from the hospital and continued to undergo dressing changes at a local hospital. The patient was followed up 3 months after discharge. All the wounds healed well, and the patient basically regained functional independence in daily life.