摘要
目的阻止大量血浆丢失,减轻坏死组织对机体的毒性反应,降低大面积深度烧伤儿童的死亡率以及缩短住院时间。方法对20例大面积烧伤儿童施行了休克期切痴植皮术(A 组)。年龄5个月至12岁,烧伤总面积28％±11.4％,Ⅲ度面积23.1％±6.2％,开始手术时间平均伤后33小时,一次切痂面积16.1％±4.6％。为评价休克期切痂效果,随机选择18例非休克期切痂植皮大面积烧伤儿童作为对照(B 组)。结果两组比较,休克期切痂组治疗过程相对平稳,所用抗生素种类少、时间短,输血量少,平均每例少输血780 ml,创面换药次数少,愈合时间明显缩短,且内脏并发症减少。结论儿童大面积深度烧伤休克期切痂植皮可提高大面积深度烧伤儿童治愈率,减少住院经费。休克期切痂植皮术不仅可在较大医院及研究所实旋,也可在基层医院内实施。
Objective To stop excessive plasma loss,to alleviate noxious effects of devitalized tis- sues on the body,to shorten the hospitalization time and to decrease the mortality of seriously burned children.Methods We have performed extensive eseharectomy and grafting during the shock period in children with large burns(Group A).Twenty children,aged 5 months to 12 years,with mean total burn area 28.0%±11.4% TBSA,and full thickness injury involving 23.1%±6.2% TBSA,underwent ex- tensive escharectomy at 33.04±18.5 hours postburn,and excision area averaged 16.1%±4.6%.Toe- valuate the clinical result of this new technology,we have randomly selected eighteen burned children with similar injuries as control group(Group B),in whom escharectomy was done on 4～7 days post- burn.Results Nineteen children have been cured in group A.Our present study demonstrates a lower mortality in pediatric burn patients treated with early extensive escharectomy(during shock stage).The data of this study also show that this new technology has following advantages.①The mean healing time and hospitalization time in group A were obviously shorter than that in group B.②The time for the grafting operations and dressing changes in group A was less.③The amount of blood transfusion in group A was 780 ml less than that in group B.④Less antibiotics were used with fewer visceral compli- cations in group A.In addition,the cost of hospitalization in pediatric patients undergone extensive es- charectomy in shock stage was 30% less than that of the control group.Conclusion Escharectomy and grafting during the burn shock stage is not only feasible but also efficient.The new technology not only can be used in large hospitals or institutes but also can be used in primary hospitals.
