在中国，延迟入院并进行适当的院前治疗可防止严重烧伤患者发生败血症：回顾性研究

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Burns Pub Date : 2024-07-31 DOI:10.1016/j.burns.2024.07.029

Runzhi Huang , Yuanan Li , Shuyuan Xian , Wei Zhang , Yifan Liu , Sujie Xie , Dayuan Xu , Yushu Zhu , Hanlin Sun , Jiale Yan , Xinya Guo , Yixu Li , Jianyu Lu , Xirui Tong , Yuntao Yao , Weijin Qian , Bingnan Lu , Jiaying Shi , Xiaoyi Ding , Junqiang Li , Shizhao Ji

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引用次数: 0

摘要

败血症是烧伤患者发病和死亡的主要原因之一。然而，能够最大限度降低败血症发生概率的最佳入院时间仍不明确。本研究旨在确定严重烧伤患者的最佳入院时间段，并找出可能的原因。研究收集了2014年8月2日昆山工厂铝粉尘爆炸事故的185名受害者。生存模型中连续变量的最佳切点是通过最大选择秩统计量确定的。进一步进行了单变量和多变量分析，以验证入院时间不是败血症的风险因素。为了找出导致这一结果的可能因素，还进行了分组分析。入院时间的临界点被确定为 7 小时，这得到了生存曲线的支持（P < 0.001）。多变量分析表明，在我们的研究人群中，入院时间延迟并不是脓毒症的风险因素（HR = 0.610, 95 %CI = 0.415 - 0.896, = 0.012）。亚组分析显示，"入院前气管切开术"（ = 0.002）、"全血输注"（ < 0.001）、"入院前血流动力学不稳定"（ = 0.02）、"医院设有烧伤科"（ = 0.009）、"医院设有烧伤重症监护室"（< 0.001）、"急性心力衰竭（AHF）"（= 0.05）、"急性呼吸窘迫综合征（ARDS）"（= 0.05）和 "消化道出血"（= 0.04）均有统计学意义。在我们的研究人群中，我们发现入院时间延迟并不是降低严重烧伤患者败血症发病率的风险因素。这可能与院前治疗（全血回输和气管切开术）、医院是否设有烧伤科/重症监护室以及某些并发症（AHF、ARDS 和消化道出血）有关。由此可以推断，早期院前护理在降低严重烧伤患者的败血症风险方面起着至关重要的作用。

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Delayed admission to hospital with proper prehospital treatments prevents severely burned patients from sepsis in China: A retrospective study

Background

Sepsis is one of the major causes of morbidity and mortality in burn patients. However, the optimal timing of admission which can minimize the probability of sepsis is still unclear. This study aims to determine the optimal time period of admission for severely burned patients and find out the possible reasons for it.

Method

185 victims to the Kunshan factory aluminum dust explosion accident, which happened on August 2nd, 2014, were studied. The optimal cutpoint for continuous variables in survival models was determined by means of the maximally selected rank statistic. Univariate and multivariate analyses were further conducted to verify that admission time was not a risk factor for sepsis. Subgroup analyses were performed to find out possible contributing factors for the result.

Result

The cutoff point for admission time was determined as seven hours, which was supported by the survival curve (p < 0.001). Multivariate analysis showed that, in our study population, delayed admission time was not a risk factor for sepsis (HR = 0.610, 95 %CI = 0.415 - 0.896, p = 0.012). Subgroup analyses showed that “Tracheotomy before admission” (p = 0.002), “Whole blood transfusion” (p < 0.001), “Hemodynamic instability before admission” (p = 0.02), “Has a burn department in the hospital” (p = 0.009), “Has a burn ICU in the hospital” (p < 0.001), “Acute heart failure (AHF)” (p = 0.05), “acute respiratory distress syndrome (ARDS)” (p = 0.05) and “GI bleeding” (p = 0.04) were all statistically significant.

Conclusion

In our study population, we found that delayed admission time was not a risk factor associated with a reduced incidence of sepsis among severely burned patients. This might be attributed to variations in prehospital treatments (whole blood transfusion and tracheotomy), whether the hospital had a burn department/ICU, and certain complications (AHF, ARDS and GI bleeding). It can be inferred that early prehospital care plays a crucial role in reducing sepsis risk among severe burn patients.

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来源期刊

Burns 医学-皮肤病学

CiteScore

4.50

自引率

18.50%

发文量

304

审稿时长

72 days

期刊介绍： Burns aims to foster the exchange of information among all engaged in preventing and treating the effects of burns. The journal focuses on clinical, scientific and social aspects of these injuries and covers the prevention of the injury, the epidemiology of such injuries and all aspects of treatment including development of new techniques and technologies and verification of existing ones. Regular features include clinical and scientific papers, state of the art reviews and descriptions of burn-care in practice. Topics covered by Burns include: the effects of smoke on man and animals, their tissues and cells; the responses to and treatment of patients and animals with chemical injuries to the skin; the biological and clinical effects of cold injuries; surgical techniques which are, or may be relevant to the treatment of burned patients during the acute or reconstructive phase following injury; well controlled laboratory studies of the effectiveness of anti-microbial agents on infection and new materials on scarring and healing; inflammatory responses to injury, effectiveness of related agents and other compounds used to modify the physiological and cellular responses to the injury; experimental studies of burns and the outcome of burn wound healing; regenerative medicine concerning the skin.