摘要：
Objective To explore the epidemiological characteristics and prevention strategy of neonatal burns in southern Henan province.Methods From February 1967 to May 2018,a total of 49 cases of neonatal burns were admitted to the burn center of the 159th Hospital of People's Liberation Army,aged 0-28 (3.57 ± 7.35) days,28 cases of male and 21 cases of female,with total 1％-46％(8.66 ± 7.29) ％ total body surface area (TBSA) burns including superficial Ⅱ degree (4.23 ± 3.79) ％TBSA,deep partial-thickness burn (7.29 ± 6.71)％ TBSA,and full thickness burn (5.73 ± 5.05)％TBSA.The average time from injury to admission was (2.79 ± 4.40) days.While admission,there were 4 cases with moderate shock and 6 cases with inhalation injury.There were 7 cases of neonatal asphyxia,2 cases of neonatal hard swelling and 1 case of hydrocephalus.All of the cases were collected and retrospectively analyzed.According to the admission time,the cases were divided into 3 groups,1960s-1970 s,1980s-1990 s,and 2000s-2010 s.And their causes,injured body parts,burn area,the times of operation,hospitalization time,complications and prognosis were comparatively analyzed.Data were processed with one-way analysis of variance,chi-square test and Fisher's exact test.Results Hot liquid scald accounted for 57.14％ of the total number of cases,26.53％ of burns caused by flame,and 6.12％ of cases by neonatal thermostat.Compared with the ages,the number of thermal scald increased,and the nunber of flame burns decreased (with P values below 0.05).The proportion of iatrogenic factors increased year by year (P ＜ 0.05).Neonatal burns were mostly injured in head,neck,trunk and limbs,while hip,perineal,digestive tract and inhalation injuries were rare,with no significant difference in the different ages (with P values above 0.05).There were no remarkable differences in burn area and burn areas of different degrees of burn among the newborns of the different ages (with P values above 0.05).The total number of operations were close,but the number of hospitalization days was gradually reduced (P ＜ 0.05).Hypoalbuminemia,electrolyte imbalance disorder and diarrhea were the most common complications in neonates.Sepsis and death rate were significantly reduced (with P values below 0.05).The total cure rate was 91.84％.Conclusions To improve the national awareness of burn prevention and first aid,standardize the nursing process of newborn babies,and reduce iatrogenic burns are the fundamental solving ways.The application of new technologies such as hemodynamic monitoring,multidisciplinary cooperation,NPWT and MEEK skin grafting are key measures for the treatments of severely burned neonates.%目的 探讨豫南地区新生儿烧伤的流行病学特点及防治策略.方法 回顾性分析解放军第一五九医院全军烧伤中心1967年2月至2018年5月收治的49例新生儿烧伤病例资料,年龄0～28 d,平均年龄(3.57 ±7.35)d,男28例,女21例.烧伤总面积1％ ～ 46％总体表面积(TBSA),平均(8.66±7.29)％TBSA,浅Ⅱ度(4.23±3.79)％TBSA,深Ⅱ度(7.29 ±6.71)％TBSA,Ⅲ度(5.73 ±5.05)％ TBSA.受伤至入院平均时间(2.79±4.40)d.入院时伴中度以上休克者4例,吸入性损伤6例,合并新生儿窒息7例,新生儿硬肿2例,脑积水1例.将所有病例按入院时间不同分为20世纪60 ～70年代、20世纪80～ 90年代和2000年至今3组,比较分析其烧伤原因、烧伤部位、烧伤面积、手术次数、住院时间、并发症及预后情况.对数据行单因素方差分析x2检验及Fisher确切概率法检验.结果 热液烫伤占全部病例总数的57.14％,火焰烧伤占26.53％,新生儿恒温箱致烧伤占6.12％.各年代间比较,热液烫伤逐渐增多,火焰烧伤逐渐减少(P值均小于0.05).医源性因素所占比例逐年上升(P值均小于0.05).新生儿烧伤以头面颈、躯干及肢体部位受伤居多,臀部、会阴、消化道及吸入性损伤较少见,各年代间差异均无统计学意义(P值均大于0.05).各年代新生儿烧伤面积及不同烧伤程度烧伤面积差异均无统计学意义(P值均大于0.05),手术次数相当,但住院时间逐渐缩短(P＜0.05).新生儿并发症仍以低白蛋白血症、电解质紊乱及腹泻居多.创面脓毒症、败血症及死亡病例现阶段明显减少(P值均小于0.05).总治愈率为91.84％.结论 提高全民烧伤防范意识及早期处理水平,规范新生儿护理流程,减少医源性烧伤,防患于未然,是解决新生儿烧伤的根本措施;液体复苏过程中重视血流动力学指标的监测,多学科联合救治,负压创面治疗技术及MEEK植皮等新技术的应用是严重烧伤新生儿救治的关键措施.
