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Abstract
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OBJECTIVE: To analyze the epidemiological characteristics of the hospitalized patients with electrical burns in Institute of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital (hereinafter referred to as Institute of Burns of Wuhan Third Hospital), so as to provide reference for the prevention and treatment of electrical burns.
METHODS: Medical records of all hospitalized burn patients in Institute of Burns of Wuhan Third Hospital from January 2004 to December 2016 were collected. Genders, ages, social categories, seasons of injury, total burn areas, depths of wounds, electrical voltages of injury, sites of wound, treatment methods, amputation rates, lengths of hospital stay, operation costs, hospitalization costs, and treatment outcomes of the electrical burn patients were collected. Treatment methods, lengths of hospital stay, operation costs, and hospitalization costs of the thermal burn patients were collected and compared with those of the electrical burn patients. Electrical voltages of injury, amputation rates, operation costs, hospitalization costs, and treatment outcomes were compared and analyzed between the electrical contact burn patients and the electrical arc burn patients. Data were processed with Chi-square test and Wilcoxon rank-sum test.
RESULTS: During the 13 years, 23 534 burn patients were admitted to Institute of Burns of Wuhan Third Hospital, among whom 2 133 (9.1%) were with electrical burns, without obvious variation in admission number of electrical burn patients every year. There were 1 418 patients (66.5%) with electrical contact burns and 715 patients (33.5%) with electrical arc burns. The ratio of male to female was 11.2∶1.0 among the electrical burn patients with known genders. The proportions of three age groups of more than 20 years old and less than or equal to 30 years old, more than 30 years old and less than or equal to 40 years old, and more than 40 years old and less than or equal to 50 years old were relatively higher, which were 18.3% (391/2 133), 22.1% (471/2 133), and 24.6% (525/2 133), respectively. The first three social category groups in proportions were workers, peasants, and preschool children, which were 57.9% (1 235/2 133), 14.6% (311/2 133), and 6.0% (128/2 133), respectively. Among the electrical burn patients with known seasons of injury, most cases were injured in summer (659 cases, accounting for 34.1%), obviously more than the proportions in autumn (537 cases, accounting for 27.8%), spring (455 cases, accounting for 23.5%), and winter (283 cases, accounting for 14.6%), with χ(2) values from 8.414 to 149.573, P values below 0.01. The group of patients with total burn areas less than 10% total body surface area (TBSA) occupied the highest proportion (1 603 cases, accounting for 75.15%), among whom 229 (10.74%) were with scattered small wounds which were less than 1% TBSA. The percentage of electrical contact burn patients with deep wounds was 79.1% (1 122/1 418), which was obviously higher than 2.5% (18/715) of the electrical arc burn patients (χ(2)=381.741, P<0.001). Among the patients with known electrical voltages of injury, patients injured by high voltage among the electrical contact burn patients accounted for 78.4% (469/598), which was obviously higher than 8.7% (11/127) of the electrical arc burn patients (χ(2)=227.893, P<0.001). The most common wound site of the electrical burn patients was upper limbs (1 650 cases, accounting for 63.2%), followed by lower limbs (382 cases, accounting for 14.6%), head and neck (292 cases, accounting for 11.2%), trunk (247 cases, accounting for 9.5%), and hip and perineum (40 cases, accounting for 1.5%). The operation rate of electrical burn patients was 32.4% (691/2 133), obviously higher than 19.1% (3 860/20 209)of the thermal burn patients during the same period (χ(2)=210.255, P<0.001). Wounds of 116 electrical contact burn patients were repaired with free flap by vascular anastomosis, of which 9 (7.8%) failed. The length of hospital stay, the operation cost, and the hospitalization cost of electrical burn patients were (28±29) d, (9 534±16 935) and (44 258±93 012) Yuan, respectively, obviously longer or higher than those of the thermal burn patients during the same period [(17±19) d, (2 990±8 916) and (23 291±88 340) Yuan, respectively, with Z values from -21.323 to -10.996, P values below 0.001]. The amputation rate and the death rate of electrical burn patients were 3.8% (82/2 133) and 0.8% (16/2 133) respectively. Compared with those of electrical arc burn patients, the amputation rate and the operation cost of electrical contact burn patients were obviously higher (χ(2)=36.970, Z=-11.351, P values below 0.001), and the length of hospital stay of electrical contact burn patients was obviously longer (Z=-5.181, P<0.001). There were no significant differences in hospitalization cost and treatment outcome between the electrical contact burn patients and the electrical arc burn patients (Z=-1.461, χ(2)=1.673, P values above 0.05).
CONCLUSIONS: The number and the proportion of hospitalized electrical burn patients in Institute of Burns of Wuhan Third Hospital were relatively high, indicating a hard task of prevention for electrical burns in Wuhan area. Working-age workers and farmers, and preschool children were the key groups in prevention from electrical burns. The length of hospital stay, the operation cost, and the hospitalization cost of electrical burn patients were obviously higher than those of thermal burn patients. The amputation rate and the operation cost of electrical contact burn patients were obviously higher than those of electrical arc burn patients, but there were no obvious differences in hospitalization cost or treatment outcome between them. Actively using tissue flaps including free flap to repair of wounds may be helpful to reduce the amputation rate, improve the results, and shorten the time of treatment.
Language: zh
目的： 分析武汉大学同仁医院暨武汉市第三医院烧伤研究所(以下简称武汉市第三医院烧伤研究所)电烧伤住院患者的流行病学特点，为电烧伤的防治提供参考依据。 方法： 收集2004年1月--2016年12月武汉市第三医院烧伤研究所所有住院烧伤患者病历资料。统计电烧伤患者性别、年龄、人群类别、受伤季节、烧伤总面积、烧伤深度、致伤电压、受伤部位、治疗方法、截肢(指、趾)率、住院时间、手术费用、住院费用、治疗结局。统计热力烧伤患者治疗方法、住院时间、手术费用、住院费用，并与电烧伤患者进行对比。另对比分析电接触烧伤和电弧烧伤患者致伤电压、截肢(指、趾)率、手术费用、住院费用、治疗结局。对数据行χ(2)检验及Wilcoxon秩和检验。 结果： 武汉市第三医院烧伤研究所13年间共收治住院烧伤患者23 534例，其中电烧伤患者2 133例，占9.1%，年收治电烧伤患者数变化不大。电烧伤患者中电接触烧伤患者1 418例(66.5%)、电弧烧伤患者为715例(33.5%)。已知性别的电烧伤患者中男女比例为11.2∶1.0。大于20岁且小于或等于30岁、大于30岁且小于或等于40岁、大于40岁且小于或等于50岁这3个年龄段电烧伤患者构成比较高，分别为18.3%(391/2 133)、22.1%(471/2 133)及24.6%(525/2 133)。电烧伤患者人群类别构成比中排前3位的分别是工人57.9%(1 235/2 133)、农民14.6%(311/2 133)、学龄前儿童6.0%(128/2 133)。已知受伤季节的电烧伤患者中，夏季受伤者最多(659例，占34.1%)，明显多于秋季(537例，占27.8%)、春季(455例，占23.5%)及冬季(283例，占14.6%)，χ(2)值为8.414～149.573，P值均小于0.01。烧伤总面积小于10%TBSA的电烧伤患者最多，共1 603例(75.15%)，其中229例(10.74%)为烧伤总面积不足1%TBSA的散在小创面患者。电接触烧伤患者中伴深度创面者占79.1%(1 122/1 418)，明显高于电弧烧伤患者中的2.5%(18/715)，χ(2)＝381.741，P<0.001。在已知致伤电压的患者中，电接触烧伤患者中高压电致伤者占78.4%(469/598)，明显高于电弧烧伤患者中的8.7%(11/127)，χ(2)＝227.893，P<0.001。电烧伤患者中受伤部位最多的为上肢(1 650例，占63.2%)，其次依次为下肢(382例，占14.6%)、头面颈部(292例，11.2%)、躯干(247例，占9.5%)及臀会阴部(40例，占1.5%)。电烧伤患者的手术率为32.4%(691/2 133)，明显高于同期热力烧伤患者的19.1%(3 860/20 209)，χ(2)＝210.255，P<0.001。116例电接触烧伤患者创面采用吻合血管的游离皮瓣修复，其中9例(7.8%)皮瓣坏死。电烧伤患者的住院时间和手术费用、住院费用分别为(28±29)d和(9 534±16 935)、(44 258±93 012)元，明显长于或高于同期热力烧伤患者的(17±19)d和(2 990±8 916)、(23 291±88 340)元(Z值为－21.323～－10.996，P值均小于0.001)。电烧伤患者的截肢(指、趾)率为3.8%(82/2 133)、病死率为0.8%(16/2 133)。与电弧烧伤患者比较，电接触烧伤患者的截肢(指、趾)率及手术费用明显增高(χ(2)＝36.970，Z＝－11.351，P值均小于0.001)，住院时间明显延长(Z＝－5.181，P<0.001)，住院费用和治疗结局无明显变化(Z＝－1.461，χ(2)＝1.673，P值均大于0.05)。 结论： 武汉市第三医院烧伤研究所电烧伤患者数量及住院患者占比均较高，提示武汉地区电烧伤预防形势严峻；工作年龄的工人、农民以及学龄前儿童是电烧伤预防的重点人群；电烧伤患者的住院时间、手术费用和住院费用明显高于热力烧伤患者；电接触烧伤患者的截肢(指、趾)率及手术费用明显高于电弧烧伤患者，但住院费用和治疗结局无明显差别；积极采用游离皮瓣等各类组织瓣修复创面，可能有助于降低电烧伤的截肢(指、趾)率、改进疗效及缩短疗程。.
Language: zh |