多中心老年和中青年严重烧伤住院患者流行病学调查分析

摘要

Objective To compare and analyze the epidemiological characteristics of hospitalized elderly,young and middle-aged patients with severe burn in recent years,so as to provide reference for the prevention and treatment of elderly patients with severe burn.Methods Relying on the entry system of epidemiological case data and biological sample of severe burn from multicenter in clinic,medical records of patients with severe burn,aged above 18,hospitalized in 8 burn wards from January 2012 to December 2015 were collected.Six hundred and fifteen patients who were more than 18 years old and less than or equal to 65 years old were included in young and middle-aged group (YM).Eighty-two patients aged more than 65 years old were included in elderly group (E).Data of age,gender,residence,education level,cause of injury,location of injury,season of injury,total burn area,occurrence and area of full-thickness burn injury,wound site,inhalation injury incidence and severity,post burn admission time,proportion of delayed resuscitation,proportion of escharectomy or tangential excision and skin grafting,preinjury systemic disease,system complication during hospitalization,length of hospital stay,outcome of treatment,and reason of abandoning treatment of patients were analyzed.Data were processed with chi-square test and Mann-Whitney U test.The odds ratios of preinjury systemic disease,system complication during hospitalization,and adverse outcome of patients in group YM were compared with those in group E.Results (1) The majority of patients in the two groups were male,but the proportion of male patients in group YM was higher.There was statistically significant difference in gender distribution of patients between the two groups (x 2 =18.727,P ＜0.001).The majority of patients in the two groups were from rural areas,but the proportion of rural patients in group E was higher.There was statistically significant difference in residence distribution of patients between the two groups (x 2 =9.306,P =0.002).Patients in group YM mainly had secondary education,while patients in group E mainly had primary education.There was statistically significant difference in distribution of education level of patients between the two groups (x 2 =146.797,P ＜ 0.001).(2) The most common causes of injury of patients in the two groups were both flame,but the proportion of patients with flame burn injury in group E was higher.There was statistically significant difference in distribution of cause of injury of patients between the two groups (x 2 =25.063,P ＜ 0.001).The main locations of injury of patients in groups YM and E were respectively public place and private residence.There was statistically significant difference in location distribution of injury of patients between the two groups (x 2 =46.313,P ＜0.001).The main seasons of injury of patients in groups YM and E were respectively summer and winter.There was statistically significant difference in season distribution of patients between the two groups (x 2 =23.143,P ＜ 0.001).There was statistically significant difference in distribution of total burn area of patients between the two groups (x 2 =25.799,P =0.002).The occurrences of full-thickness burn injury of patients in the two groups were similar (x 2 =2.685,P =0.101),while there was statistically significant difference in area of full-thickness burn injury of patients between the two groups (x 2 =26.702,P =0.002).There was no statistically significant difference in distribution of wound site of patients between the two groups (x 2 =3.954,P =0.785).There were no statistically significant differences in incidence and severity distribution of inhalation injury of patients between the two groups (withx 2 values respectively 0.425 and 0.672,P values above 0.05).(3) There was statistically significant difference in distribution of admission time of patients between the two groups (x 2 =6.632,P =0.036),but there was no statistically significant difference in proportion of delayed resuscitation of patients between the two groups (x 2 =1.261,P =0.261).The proportion of escharectomy or tangential excision and skin grafting of patients in group YM was 72.0％ (443/615),which was significantly higher than 35.4％ (29/82) of group E (x2 =44.498,P ＜0.001).The incidence of preinjury systemic disease of patients in group YM was 13.2％ (81/615),which was significantly lower than 61.0％ (50/82) of group E (x 2 =108.337,P ＜ 0.001).The risk of preinjury systemic disease of patients in group E was 10.30 times of that of patients in group YM [with 95％ confidence interval (CI) of 6.24-17.01,P ＜0.001].During hospitalization,59.8％ (49/82) of patients in group E suffered from system complications,which was significantly higher than 36.6％ (225/615) of group YM (x2 =16.282,P ＜0.001).The risk of system complication of patients in group E was 2.57 times of patients in group YM (with 95％ CI of 1.61-4.12,P ＜ 0.001).The length of hospital stay of patients in group E was significantly shorter than that of group YM (U =36 735,P ＜ 0.001).There was statistically significant difference in treatment outcome of patients between the two groups (x 2 =106.251,P ＜ 0.001).The risk of adverse outcome of patients in group E was 7.52 times of group YM (with 95％ CI of 4.40-12.88,x 2 =67.709,P ＜ 0.001).The proportion of abandoning treatment of patients in group E was significantly higher than that of group YM (x 2 =150.670,P ＜ 0.001).The risk of abandoning treatment of patients in group E was 15.86 times of that of group YM (with 95％ CI of 9.36-26.88,P ＜0.001).There was no statistically significant difference in distribution of reason of abandoning treatment of patients between the two groups (x 2 =4.178,P =0.243).Conclusions There were significant differences in the epidemiological characteristics of patients in groups E and YM.In elderly burn patients,the proportion of rural population was higher and the education level was lower.Flame burn was common and burns mostly occurred in private residences and in winter.The total burn area was slightly lower but the area of full-thickness burn injury was larger.The length of hospital stay was shorter and the proportion of surgical treatment was lower.The incidences of preinjury systemic disease and system complication during hospitalization were higher,and therefore the risks of adverse outcome and abandoning treatment were higher.%目的 对比分析近年来我国老年和中青年严重烧伤住院患者的流行病学特征,为老年严重烧伤的预防与救治提供参考依据. 方法 依托“临床多中心严重烧伤流行病学病例数据与生物样本录入系统”,收录8家笔者单位2012年1月-2015年12月收治的18岁以上严重烧伤住院患者的病历资料.将615例年龄大于18岁且小于或等于65岁的患者划分为中青年组,将82例大于65岁的患者划分为老年组,分别统计如下指标:年龄、性别、居住地、教育程度、致伤原因、致伤场所、致伤季节、烧伤总面积、Ⅲ度烧伤发生情况和面积、致伤部位、吸入性损伤发生情况及严重程度、伤后入院时间、延迟复苏比例、切削痂植皮手术比例、伤前系统疾病和住院期间系统并发症,住院天数、治疗结局与放弃治疗原因.对数据行x 2检验、Mann-Whitney U检验.对比老年组患者相对于中青年组患者在伤前系统疾病、住院期间系统并发症及不良结局中的比值比. 结果 (1)2组患者均以男性居多,但中青年组中男性患者所占比例更高.2组患者性别分布差异明显(x2=18.727,P＜0.001).2组患者均以农村患者居多,但老年组农村患者所占比例更高.2组患者居住地分布差异明显(x2=9.306,P=0.002).中青年组患者以中等教育者居多,老年组患者以初等教育者居多.2组患者教育程度分布差异明显(x2=146.797,P＜0.001).(2)2组患者最常见的致伤原因均为火焰烧伤,但老年组患者火焰烧伤比例更高.2组患者致伤原因分布差异明显(x2 =25.063,P＜0.001).中青年组患者的主要致伤场所为公共场所,老年组患者的主要致伤场所为私人住宅.2组患者致伤场所分布差异明显(x2 =46.313,P＜0.001).中青年组和老年组患者最常见致伤季节分别为夏季和冬季.2组患者致伤季节分布差异明显(x2 =23.143,P＜0.001).2组患者烧伤总面积分布差异明显(x2=25.799,P=0.002).2组患者Ⅲ度烧伤发生情况相近(x2=2.685,P=0.101),Ⅲ度烧伤面积分布差异明显(x2=26.702,P=0.002).2组患者致伤部位分布差异无统计学意义(x2=3.954,P =0.785).2组患者吸人性损伤的发生率及严重程度分布差异无统计学意义(x2值分别为0.425、0.672,P值均大于0.05).(3)2组患者入院时间分布差异明显(x2=6.632,P=0.036),但延迟复苏比例相近(x2=1.261,P=0.261).中青年组患者中行切削痂植皮手术比例为72.0％(443/615),高于老年组患者的35.4％(29/82,x2=44.498,P＜0.001).中青年组患者中伤前系统疾病的发生率为13.2％ (81/615),明显低于老年组患者的61.0％(50/82,x2=108.337,P＜0.001).老年组患者出现伤前系统疾病的风险是中青年组患者的10.30倍(95％置信区间为6.24～17.01,P＜ 0.001).住院期间,老年组共59.8％ (49/82)患者出现系统并发症,高于中青年组的36.6％(225/615,x2=16.282,P＜0.001);老年组患者出现系统并发症的风险为中青年组患者的2.57倍(95％置信区间为1.61～4.12,P＜0.001).老年组患者住院天数明显短于中青年组(U=36 735,P＜ 0.001).2组患者治疗结局分布差异明显(x2=106.251,P＜0.001).老年组患者出现不良结局的风险为中青年组患者的7.52倍(95％置信区间为4.40 ～ 12.88,x2=67.709,P＜0.001).老年组患者放弃治疗比例明显高于中青年组(x2=150.670,P＜0.001),老年组患者放弃治疗的风险为中青年组患者的15.86倍(95％置信区间为9.36～26.88,P＜0.001).2组患者放弃治疗的原因分布差异无统计学意义(x2 =4.178,P=0.243). 结论 老年与中青年组严重烧伤患者的流行病学特征存在明显差异,老年严重烧伤患者农村人口比例更高、教育程度更低、更多见火焰烧伤、多发生在私人住宅和冬季、烧伤总面积略小但Ⅲ度烧伤面积更大、住院天数更短、手术治疗比例更低、伤前系统疾病及住院期间系统并发症发生率更高、出现不良结局及放弃治疗的风险更高.