背景:严重烧伤,尽管在护理和预防方面取得了进步,会对长期发病率产生深远的影响,影响生活质量和社会经济地位。我们的目标是探索预测独立恢复的因素,严重烧伤患者的预期速度和时间,以及使用的进展衡量标准。
方法:对四个数据库的系统搜索(MEDLINE,EMBASE,Cochrane,CINAHL)进行了一项研究,该研究报告了与成年(>15岁)队列中独立功能的身体能力有关的结果,这些队列在开发的专业烧伤服务中治疗后长达30年遭受严重烧伤(>20%TBSA)。提取的数据包括五个独立域中影响功能实现速率和时间的因素,以及使用的结果衡量标准。
结果:纳入21项符合条件的研究,包括1298名重度烧伤幸存者,合并平均年龄为39.6岁,平均TBSA为25.8%。影响独立功能恢复的最重要的复发因素是年龄,女性性别,烧伤严重程度,延长ICU和住院时间,先前的精神健康状况,和急性后的心理问题。即使在受伤后的2年以上,基于运动的康复也为主要烧伤患者带来了好处。27%至97%的患者出院至独立生活,而报告的复工率从52%到80%不等。烧伤特定健康量表-简介,功能独立性度量,物理综合评分(SF-36)是最广泛使用的结果评分系统。
结论:主要烧伤幸存者的恢复时间较长,有可能出现持续性慢性损伤,始终低于基线功能水平。年龄和性别等不可改变的因素,和疾病特征,如烧伤大小与相关的身体,生理和心理后遗症是促成的。需要进一步的研究来探索重大烧伤和多发性创伤重症监护患者的具体里程碑的成就,虽然早期有针对性的康复解决身体问题,心理,和职业需求有前途的潜在利益。
BACKGROUND: Major burn injury, despite advancements in care and prevention, can have a profound impact on long-term morbidity, affecting quality of life and socioeconomic standing. We aim to explore factors predicting recovery of independence, the expected rate and time in majorly burned patients, and the measures of progress used.
METHODS: A systematic search of four databases (MEDLINE, EMBASE, COCHRANE, CINAHL) was conducted for studies reporting outcomes pertaining to physical ability indicative of independent function in adult (>15 y) cohorts who had suffered a
major burn (>20% TBSA) up to 30 years after treatment in a developed specialised burn service. Data extracted included factors affecting rate of and time to achievement of function in five independence domains, as well as the outcome measures used.
RESULTS: 21 eligible studies were included comprising 1298
major burns survivors with a combined mean age of 39.6 y and a mean TBSA of 25.8%. The most significant recurring factors impacting recovery of independent function were older age, female gender, burn severity, prolonged ICU and hospital admission, preceding mental health conditions, and post-acute psychological issues. Exercise-based rehabilitation conferred benefits on
major burn patients even over 2 years following injury. Discharge to independent living from hospital occurred in 27% to 97% of patients, while reported return to work rates varied from 52% to 80%. Burns Specific Health Scale-Brief, Functional Independence Measure, and Physical Composite Score (SF-36) were the most widely used outcome scoring systems.
CONCLUSIONS: Major burn survivors have protracted recovery with potential for persistent chronic impairments, remaining consistently below baseline levels of function. Non-modifiable factors such as age and gender, and disease characteristics such as burn size with associated physical, physiological and psychosocial sequelae are contributory. Further research is required to explore achievement of specific milestones of
major burn and polytrauma critical care patients, while early targeted rehabilitation addressing physical, psychological, and vocational needs has promising potential benefit.