摘要
目的 分析内蒙古自治区中西部及相关地区儿童烧伤的流行病学特征,为寻找针对性防治措施提供依据. 方法 收集解放军第二五三医院、解放军第三二二医院、内蒙古自治区医院1996年1月-2010年12月住院烧伤儿童病历资料,根据主要致伤原因将病例分为特定因素烧伤组（“锅连炕”构造缺陷导致烫伤,以下称烧伤；简称特因组）和其他原因烧伤对照组（简称对照组）.统计2组患儿一般情况、家庭背景、发病周期及病情转归,比较采取“锅连炕”防护措施前后2个时间段（1996-2001年和2002-2010年）流行病学变化趋势.组间比较采用x2检验或秩和检验. 结果 （1）一般情况：共纳入16 595例烧伤儿童,其中热液烧伤15 816例占95.3％,非热液烧伤779例占4.7％.特因组患儿5089例占热液烧伤的32.2％,占烧伤住院儿童总数的30.7％；收治比例以解放军第三二二医院最多,占该院住院烧伤患儿的34.2％ （1803/5267）.对照组为11 506例,占烧伤住院儿童总数的69.3％.特因组患儿发病年龄为8个月～5岁,对照组1个月～12岁,2组患儿年龄均以1～3岁居多.特因组男女性别比例为2.1∶1.0,对照组为1.4∶1.0.特因组3590例患儿同时累及多个部位的比例（70.5％,3590/5089）,明显高于对照组（54.8％,6311/11 506,x2=361.138,P＜0.01）.2组患儿烧伤部位发生率排列顺序相同,从高到低依次是上肢、下肢、头面颈、躯干.特因组烧伤程度总体上重于对照组（Z=27.770,P＜0.01）,院前未处理率[31.2％ （1588/5089）]明显高于对照组[24.8％（2857/11 506）,x2 =73.010,P＜0.01],冷疗处理率[14.7％ （747/5089）]明显低于对照组[19.6％（2255/11 506）,x2=57.636,P＜0.01],伤后6h延迟复苏率[31.5％ （1601/5089）]明显高于对照组[7.8％（897/11 506）,x2=1545.234,P＜0.01].（2）家庭背景及发病周期：特因组患儿家庭背景分别为农村67.3％（3424/5089）、乡镇22.1％ （1123/5089）、城市10.7％（542/5089）,对照组为农村32.4％ （3727/11 506）、乡镇48.4％（5570/11 506）、城市19.2％（2209/11 506）.特因组以当年10月至次年3月为发病高峰期占77.8％（3958/5089）,对照组每年5-10月份发病居多[58.2％ （6697/11 506）].（3）病情转归及流行病学变化趋势：特因组患儿治愈率为32.3％（1645/5089）,低于对照组的44.7％（5143/11 506,x2=215.615,P＜0.01）；病死率为1.6％（79/5089）,高于对照组的0.4％（46/11 506,x2=62.700,P＜0.01）.1996-2001年,特因组占热液烧伤患儿的42.5％（2213/5212）,对照组占57.5％（2999/5212）;采取“锅连炕”防护措施后,2002-2010年,特因组为27.1％ （2876/10 604）,对照组为72.9％ （7728/10 604）,两个时间段比较差异有统计学意义（x 2 =376.695,P＜0.01）. 结论 “锅连炕”构造是内蒙古自治区中西部地区小儿烧伤发病率高的主要因素之一,在锅与炕之间安装防护栏可以明显降低发病率.特殊致伤因素、院前创面处理不正规、休克延迟复苏,是引起患儿致死率和致残率增加的主要原因和今后防治工作的重点.
Objective To analyze the epidemiological characteristics of pediatric burn in the midwest region of Inner Mongolia and the related areas,and to provide reference for seeking pertinent measures of prevention and treatment.Methods Medical records of patients hospitalized in the 253rd Hospital of PLA,the 322nd Hospital of PLA,and the Inner Mongolia Autonomous Region Hospital from January 1996 to December 2010 were collected.Patients were divided into pediatric burn group with specific reason （group SF,with scald resulted from construction defect of Guo-lian-kang--a heatable brick bed linked to a cooking pot）,and burn control group with other causes （group C） according to the main injury cause.Clinical data of patients in both groups,including general condition,family background,occurrence regularity,and outcome,were analyzed.The epidemiological trend of variation before and after taking preventive measures （1996 to 2001 and 2002 to 2010） was compared.Data were processed with chi-square test and rank sum test.Results （1） General condition：out of 16 595 pediatric burn patients,15 816 cases （95.3％） suffered scald due to liquids with high temperature,and 779 cases （4.7％） suffered burns due to other causes.Patients in group SF （scald due to specific cause--Guo-lian-kang） accounted for 32.2％ （5089/15 816） of the total suffered scald by liquids with high temperature,and 30.7％ （5089/16 595） of all the inpatients the cause of burn was related to Guo-lian-kang （group SF）.The patients in group SF admitted to the 322nd Hospital of PLA accounted for 34.2％ of all the inpatients admitted to this hospital （1803/5267）,more than the other two hospitals in this study.The number of patients in group C was 11 506,accounted for 69.3％ of all the inpatients.The age of patients ranged from 8 months to 5 years in group SF and 1 month to 12 years in group C.The age of the majority of patients ranged from 1 to 3 years in both groups.The ratio of male to female was 2.1∶1.0 in group SF and 1.4∶1.0 in group C.The incidence of scald involving multiple body parts in group SF （3590 cases accounting for 70.5％） was obviously higher than that of group C （6311 cases accounting for 54.8％,x2 =361.138,P ＜ 0.01）.In both group SF and group C,the incidence in differ-ent sites was ranked from high to low as follows：upper limbs,lower limbs,the head-face-neck region,and the trunk.The degree of injury in group SF was much more severe than that of group C （Z =27.770,P ＜0.01）.The rate of patients without pre-hospital treatment was 31.2％ （1588/5089） in group SF,which was obviously higher than that of group C （24.8％,2857/11 506,x2 =73.010,P ＜ 0.01）.The rate of patients treated with cryotherapy was obviously lower in group SF （14.7％,747/5089） than in group C （19.6％,2255/11 506,x2 =57.636,P ＜ 0.01）.The rate of patients treated with delayed resuscitation （6 hours after injury） in group SF （31.5％,1601/5089） was obviously higher than that of group C （7.8％,897/11 506,x2 =1545.234,P ＜ 0.01）.（2） Family background and occurrence regularity：in group SF,67.3％ （3424/5089） of the patients came from farming area,22.1％ （1123/5089） from villages and towns,and 10.7％ （542/5089） from urban areas.In group C,32.4％ （3727/11 506） of the patients came from farming area,48.4％ （5570/11 506） from villages and towns,and 19.2％ （2209/11 506） from urban areas.Most of the patients in group SF （77.8％,3958/5089） were injured between October and March,while most of the patients in group C （58.2％,6697/11 506） were injured between May and October.（3） Outcome and epidemiological variation：the cure rate of patients in group SF was 32.3％（1645/5089）,which was obviously lower than that of group C （44.7％,5143/11 506,x2 =215.615,P ＜0.01）.The mortality of patients in group SF was 1.6％ （79/5089）,and it was obviously higher than that of group C （0.4％,46/11 506,x2 =62.700,P ＜0.01）.From 1996 to 2001,patients in group SF accounted for 42.5％ （2213/5212）,while patients in group C accounted for 57.5％ （2999/5212） of the inpatients scalded by hot liquid.After taking preventive measures against injury due to Guo-lian-kang,incidence of scald injury in group SF was lowered to 27.1％ （2876/10 604）,while the incidence in group C remained at 72.9％ （7728/10 604） of the inpatients with hot liquid scald from 2002 to 2010.The difference between the two periods was statistically significant （x2 =376.695,P ＜ 0.01）.Conclusions The defect of construction of Guo-lian-kang is one of the main factors that lead to a high incidence of pediatric burn in the midwest of Inner Mongolia.Installation of a protective bannister between the cooking pot and the ＂ kang （heatable brick bed） ＂ can obviously reduce the incidence of scald injury.Special injury-causing factors,unprofessional pre-hospital treatment of the wound,delayed resuscitation after shock are the main causes of increasing mortality and disability,and they constitute the key targets of prevention and treatment of such injury in future.
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2013年第1期6-10,共5页
Chinese Journal of Burns
基金
内蒙古自然科学基金
关键词
烧伤
儿童
回顾性研究
锅连炕
Burns
Child
Retrospective studies
Guo-lian-kang
