灼熱の大きさと現代の灼熱ケアにおける小児患者の生存確率:前向きな観察コホート研究
Robert Kraft1, David N Herndon, Ahmed M Al-Mousawi
1Shriners Hospitals for Children, Galveston, TX, USA.
Lancet (London, England)
|February 3, 2012
まとめ
全体表面積 (TBSA) の60%を超える灼熱の大きさは,小児患者の死亡率と罹患率を大幅に増加させます. 重度の火傷が60%以上の子供には,早期に専門の火傷センターへの移送が推奨されます.
科学分野:
- 小児の灼熱ケアについて
- トラウマ・外科・外科
- クリティカルケア・メディシン
背景:
- 重度の火傷後の患者の生存率は,火傷の大きさと強く相関しています.
- 灼熱治療の進歩により治療結果が改善されていますが,小児の集団における大規模な分析は限られています.
- この研究は,小児患者の罹病率と死亡率に影響を与える重要な燃焼サイズの値を特定することを目的とした.
研究 の 目的:
- 小児の灼熱患者における罹患率と死亡率の増加に関連した特定の灼熱サイズを決定する.
- 有害な結果のリスクが著しく高いことを示す燃焼サイズのための値を設定する.
- 重度な火傷を負った子供たちの治療プロトコルと移送決定に情報を提供するためです.
主な方法:
- 単一センターの前向きな観察コホート研究では,焼け傷の30%以上のTBSAを有する952人の小児患者が含まれていました.
- 患者は,燃焼の大きさによって10% (30-100% TBSA) の増加で階層化されました.
- 統計分析には,学生のtテスト,チ2テスト,ロジスティック回帰,ROC分析 (p<0.05有意度) が含まれていた.
主要な成果:
- 死亡率は,火傷の大きさに伴い,3% (30-39% TBSA) から55% (90-100% TBSA) (p<0.0001) まで著しく増加した.
- 多臓器不全 (16%) とセプシス (9%) の割合も,より大きな燃焼サイズ (p<0.0001) に伴って上昇した.
- 62%のTBSAの燃焼サイズが死亡率の重要な値として特定されました (OR 10.07,p<0.0001).
結論:
- 近代的な小児の灼熱治療では,約60%のTBSAの灼熱サイズが,罹病率と死亡率の増加の重要な値を表しています.
- 60%を超えるTBSAの灼傷を持つ小児患者は,専門の灼傷センターに直ちに移送されるべきです.
- 高いリスクのために,燃焼>60%のTBSAを有する患者にとって,警戒心と高度な治療が不可欠です.
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