本文關(guān)鍵詞： 電動車起火 成批燒傷 吸入性損傷　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景燒傷主要指熱力、化學(xué)物質(zhì)、電能、放射線等引起的皮膚、黏膜甚至深部組織的損害,其中以熱力燒傷(如熱水、火焰等)最為多見[1]。我國燒傷醫(yī)學(xué)經(jīng)過50多年的風(fēng)雨歷程和幾代人的努力,無論在臨床診治水平還是基礎(chǔ)理論研究方面都取得了令人矚目的的巨大成就,多年來,燒傷總治愈率,特別是嚴(yán)重大面積燒傷治愈率一直遙居世界前列,在歷年重大災(zāi)難性事件中發(fā)揮了巨大作用。近年來,隨著社會經(jīng)濟建設(shè)的快速發(fā)展,因工業(yè)化時代高能損傷造成成批燒傷事件不斷發(fā)生,因成批燒傷患者具有突發(fā)性強、相對集中、數(shù)量多、傷情復(fù)雜等特點,使得患者救治難度大,成批燒傷事故發(fā)生后,不僅給傷員和事故單位帶來了巨大損失,也造成了巨大的社會影響。目的1、回顧性分析南寧市近兩年電動車起火致成批燒傷患者的臨床病例資料,探討成批燒傷患者的發(fā)病特點、影響其預(yù)后的相關(guān)因素,總結(jié)治療經(jīng)驗,為進(jìn)一步提高成批燒傷的治愈率提供臨床參考依據(jù)。2、為制定南寧市今后成批燒傷患者的診治流程提供參考依據(jù)。方法收集2015年1月1日至2016年12月31日南寧市電動車起火致成批燒傷病人的病歷資料,排除因個人原因未治療者。統(tǒng)計起火原因、時間、地點及人數(shù),每個病人的性別、年齡、燒傷總面積(%TBSA)、Ⅲ度燒傷面積、吸入性損傷、機械通氣、纖支鏡應(yīng)用情況、復(fù)合傷、休克、感染及內(nèi)臟并發(fā)癥的發(fā)生情況及預(yù)后情況,總結(jié)治療經(jīng)驗。結(jié)果1、在17批173例病例中,14批發(fā)生在夜間,3批發(fā)生在白天;14批發(fā)生在室內(nèi),3批發(fā)生在室外;10批電動車起火的原因是充電時間過長;門診治療108人,住院治療65人;20-49歲年齡段的患者發(fā)病率高,占患者總數(shù)的61.62%;燒傷程度以輕中度為主,占所有病例73.58%,合并肺部爆震傷3例,軟組織傷10例,骨折2例,顱腦損傷1例,2、吸入性損傷的程度:輕度63例(52.94%),中度39例(32.77%),重度17例(14.29%),以輕中度為主。3、本組患者共死亡9例,病死率為5.20%,其中男5例,女4例。死亡主要死亡原因:吸入性損傷7例(77.78%),重度顱腦損傷1例(11.11%),復(fù)合傷合并大面積燒傷1例(11.11%)。4、吸入性損傷及嚴(yán)重程度、機械通氣、纖維支氣管鏡應(yīng)用與患者預(yù)后相關(guān),吸入性損傷是影響成批燒傷患者預(yù)后的主要獨立危險因素。結(jié)論1、電動車起火致成批燒傷事故主要發(fā)生在夜間、室內(nèi),不容易發(fā)現(xiàn),直至煙霧吸入后發(fā)現(xiàn)。2、本批患者在密閉空間環(huán)境導(dǎo)致吸入性損傷,以煙霧吸入性損傷為主,比普通常見皮膚燒傷治療難度大;皮膚燒傷較輕,小于10%體表燒傷面積的患者占69.94%。3、影響電動車起火致成批燒傷患者預(yù)后的主要因素是吸入性損傷,吸入性損傷患者行氣道灌洗(纖支鏡清理)后可明顯降低死亡率。
[Abstract]:Background Burn mainly refers to the damage of skin, mucous membrane and even deep tissue caused by heat, chemical, electric energy, radiation and so on, among which thermal burns (such as hot water, flame, etc.) are the most common. [1. Burn medicine in China has made great achievements in clinical diagnosis and treatment and basic theory research after more than 50 years of hard work. The total cure rate of burn, especially the cure rate of severe large area burn, has always been in the forefront of the world, and has played a great role in the major and disastrous events of the past years. In recent years, with the rapid development of social and economic construction. Because of the industrial era high energy injury caused by the batch of burn events continue to occur, because of the group of burn patients with sudden strong, relatively concentrated, the number of injuries, complex injuries and other characteristics, so that the treatment of patients is very difficult. After mass burn accidents, not only the injured and accident units have brought huge losses, but also caused a huge social impact. Objective 1. The clinical data of burn patients caused by electric vehicle fire in Nanning in recent two years were analyzed retrospectively. To provide clinical reference for further improving the cure rate of burn in batches. 2. Methods from January 1st 2015 to December 31st 2016, the medical records of burn patients caused by electric vehicle fire in Nanning City were collected. Material. The patients who were not treated for personal reasons were excluded. The cause, time, location and number of the fire were counted, the sex, age, total area of burn, area of third degree burn, inhalation injury, mechanical ventilation of each patient were calculated. The application of fiberoptic bronchoscopy, compound injury, shock, infection, visceral complications and prognosis were summarized. Results 1. In 17 groups of 173 cases, 14 cases occurred at night. 3 batches occurred during the day; 14 batches occurred in indoor and 3 batches outside. 10 batches of electric vehicles caught fire because the charging time is too long; 108 outpatients and 65 inpatients; The incidence rate of patients aged 20-49 years was high, accounting for 61.62% of the total number of patients. The degree of burn was mainly mild and moderate, accounting for 73.58% of all cases, including 3 cases of lung blast injury, 10 cases of soft tissue injury, 2 cases of fracture and 1 case of craniocerebral injury. The degree of inhalation injury: mild 63 cases (52.94g), moderate 39 cases (32.77), severe 17 cases (14.29%), mild to moderate (3 cases). 9 cases died in this group. The mortality rate was 5.20%, including 5 males and 4 females. The main causes of death were as follows: inhalation injury in 7 cases, severe craniocerebral injury in 1 case, and severe craniocerebral injury in 1 case. One case of compound injury complicated with large area burn was 11.11%. The degree of inhalation injury, mechanical ventilation and fiberoptic bronchoscopy were related to the prognosis of the patients. Inhalation injury is the main independent risk factor affecting the prognosis of burn patients. Conclusion 1. Mass burn accidents caused by electric vehicle fire mainly occur at night and are not easily found indoors. Until the smoke inhalation found. 2, this group of patients in the closed space environment resulting in inhalation injury, mainly smoke inhalation injury, than ordinary common skin burn treatment is more difficult; The number of patients with skin burn less than 10% was 69.94.3. the main factor affecting the prognosis of burn patients caused by electric vehicle fire was inhalation injury. Airway lavage (fiberoptic bronchoscopy) can significantly reduce mortality in patients with inhalation injury.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R644

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