摘要
目的探讨大面积烧伤患者继发持续炎症-免疫抑制-分解代谢综合征(PICS)的危险因素和治疗结局。方法采用回顾性病例系列研究方法。2017年1月—2021年12月,暨南大学附属广州红十字会医院收治220例符合入选标准的大面积烧伤患者,其中男168例、女52例,年龄18~84(43±14)岁。按照PICS发生情况,将患者分为PICS组(84例)和非PICS组(136例)。收集并分析2组患者性别、年龄、入院时合并基础疾病情况和急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、入院时和入院14 d脓毒症相关性器官功能衰竭评价(SOFA)评分、治疗期间行机械通气超过48 h比例等一般资料,烧伤总面积、Ⅲ度烧伤面积、伤后48 h内入院比例、伤后30 d深度创面暴露面积等专科情况,住院天数、住院总费用、手术次数以及死亡情况等结局指标。对数据行独立样本t检验、Mann-Whitney U检验、χ^(2)检验。对除结局指标外2组比较差异有统计学意义的指标行多因素logistic回归分析,筛选大面积烧伤患者继发PICS的独立危险因素。结果PICS组患者入院时APACHEⅡ评分和SOFA评分、治疗期间行机械通气超过48 h比例均明显高于非PICS组(t=6.78,Z=-4.75,χ^(2)=4.74,P<0.05);2组患者其余一般资料比较,差异均无统计学意义(P>0.05)。PICS组患者烧伤总面积、Ⅲ度烧伤面积、伤后30 d深度创面暴露面积均明显大于非PICS组(t=6.29,Z=-7.25,Z=-8.73,P<0.05),其中PICS组、非PICS组患者伤后30 d深度创面暴露面积分别为25%(15%,35%)体表总面积(TBSA)、8%(0,13%)TBSA;但伤后48 h内入院比例明显低于非PICS组(χ^(2)=6.13,P<0.05)。PICS组患者住院天数、住院总费用、手术次数均明显多于非PICS组(Z值分别为-7.12、-8.48、-6.87,P<0.05),但2组患者死亡情况相近(P>0.05)。入院时APACHEⅡ评分、伤后30 d深度创面暴露面积均是大面积烧伤患者继发PICS的独立危险因素(比值比分别为1.15、1.07,95%置信区间�
Objective To investigate the risk factors and treatment outcome of persistent inflammation-immunosuppression-catabolism syndrome(PICS)in patients with extensive burns.Methods A retrospective case series study was conducted.From January 2017 to December 2021,220 patients with extensive burns who were admitted to Guangzhou Red Cross Hospital of Jinan University met the inclusion criteria,including 168 males and 52 females,aged 18-84(43±14)years.According to the occurrence of PICS,the patients were divided into PICS group(84 patients)and non-PICS group(136 patients).The general data such as sex,age,complication of underlying diseases and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score on admission,sepsis-related organ failure evaluation(SOFA)scores on admission and 14 days post admission,and proportion of patients with mechanical ventilation over 48 h during treatment,special conditions such as total burn area,full-thickness burn area,proportion of patients admitted within 48 h post injury,and exposed deep wound area at the 30th day post injury,outcome indicators such as hospitalization day,total cost of hospital stay,number of surgeries,and death of patients in the 2 groups were collected and analyzed.Data were statistically analyzed with independent sample t test,Mann-Whitney U test,and chi-square test.The multivariate logistic regression analysis was performed on the indicators with statistically significant differences between the two groups except for outcome indicators,and the independent risk factors influencing secondary PICS in patients with extensive burns were screened.Results The APACHEⅡand SOFA scores on admission,and proportion of patients with mechanical ventilation over 48 h during treatment of patients in PICS group were significantly higher than those in non-PICS group(t=6.78,Z=-4.75,χ^(2)=4.74,respectively,P<0.05).There were no statistically significant differences in the rest of general data of patients between the two groups(P>0.05).The total burn area,full-thickness burn a
作者
汤文彬
陈宾
欧莎莉
李欣滢
肖逵
王思思
李孝建
Tang Wenbin;Chen Bin;Ou Shali;Li Xinying;Xiao Kui;Wang Sisi;Li Xiaojian(Department of Burns and Plastic Surgery,Guangzhou Red Cross Hospital of Jinan University,Guangzhou 510220,China)
出处
《中华烧伤与创面修复杂志》
CAS
CSCD
北大核心
2023年第4期350-355,共6页
Chinese Journal of Burns And Wounds
基金
广州市科技计划项目(202102010058)
广州市医学重点学科
广州市卫生健康科技项目一般引导项目(20221A010016)
广州市科学技术局2022年基础研究计划项目(202201020003)。
