ABSTRACT
@#Burns often happen unexpectedly and have the potential to cause death, lifelong disfigurement and dysfunction.[1] According to the depth of the burn wound and extent of affected burned body surface area, burns are classified as mild or severe. Mild burns usually refer to burns that encompass less than 10% of the total body surface area (TBSA), mainly superficial burns. Severe burns are defined as TBSA >10% in elderly patients, TBSA>20% in adults, and TBSA>30% in children.[2] Burn injuries, particularly severe burns, are accompanied by an immune and inflammatory response, metabolic changes and distributive shock that can be challenging to manage and can lead to multiple organ failure.[3] Therefore, burn care providers face many challenges, including acute and critical care management, long-term care, and rehabilitation. Here, we report a 94-year-old patient with severe burns who recovered well and was discharged from the hospital in a wheelchair.
ABSTRACT
Objective To compare changes in indexes and analyze their values in prognosis of severe burn patients with sepsis.Methods A retrospective analysis was conducted. The patients with severe burn sepsis admitted to the Third Affiliated Hospital of Soochow University from August 2014 to December 2016 were enrolled. The blood culture was positive in the clinical diagnosis of sepsis. According to the prognosis, the patients were divided into death group and survival group. Their general information, vital signs, blood routine examination, serum sodium (Na+), serum glucose (Glu), C-reactive protein (CRP) and arterial partial pressure of carbon dioxide (PaCO2) at the time of admission and diagnosis of sepsis as well as the level of serum procalcitonin (PCT) at admission, diagnosis of sepsis and 1-8 days of post diagnosis were also compared. Receiver operating characteristic curve (ROC) was used to analyze the prognostic value of each index, and multivariate Cox regression analysis was used to analyze the influence of each index on the survival time, and the survival curve of Kaplan-Meier was analyzed for dead patients.Results There were 25 cases of severe burn patients with sepsis, which were admitted to hospital within 12 hours after injury; the time of diagnosis of burn sepsis was (14±6) days; 8 cases of survival; 17 cases died, the mortality rate was 68.0%, the time from diagnosis of sepsis to death was (28±14) days. The age of the death group was significantly higher than that of the survival group (years: 41±12 vs. 29±9,t = 2.598,P = 0.016), but there was no significant difference in the gender, total burn area,Ⅲ degree area, and the time of diagnosis of sepsis between the two groups. The platelet count (PLT) at the diagnosis of sepsis in death group was significantly lower than that of the survival group (×109/L: 69±43 vs. 180±108,t = -2.773, P = 0.023), and the PCT at 1-8 days of post-diagnosis in the death group was significantly higher than that of survival group [μg/L: 4.4 (2.2, 9.0) vs. 1.6 (0.7, 2.3),Z = -2.521,P = 0.012], but there was no significant difference in body temperature, heart rate, white blood cell count (WBC), percentage of neutrophils (Neu), Na+, Glu, CRP, PCT, PaCO2 at the time of admission and diagnosis of sepsis and PLT at the time of admission between the two groups. ROC curve analysis showed that the area under ROC curve (AUC) of age, PLT at the time of diagnosis and PCT at 1-8 days of post-diagnosis of sepsis was 0.808, 0.779, 0.825, respectively, for predicting the prognosis of patients with severe burn sepsis (allP < 0.05). At the cut-off age of 32, the sensitivity was 73.3% and the specificity was 75.0%. As the cut-off of PLT was 138×109/L at the time of diagnosis, the sensitivity was 92.3% and the specificity was 75.0%. As the cut-off of PCT was 2.39μg/L at 1-8 days of post-diagnosis of sepsis, the sensitivity was 73.3% and the specificity was 87.5%. Multivariate Cox regression analysis showed that age and PLT at the time of diagnosis were the favorable factors for the survival time of patients with severe burn sepsis (β value were -1.834, -0.029, respectively, bothP < 0.05). Kaplan-Meier survival analysis for patients in the death group showed that the median survival time of patients ≥32 years old was longer than that of patients < 32 years old (days: 32 vs. 9); 18-day cumulative survival rate was significantly higher than that of patients < 32 years old [83.3% (10/12) vs. 25.0% (1/4),χ2 = 9.705,P = 0.003].Conclusion Age, PLT at diagnosis of sepsis and PCT at 1-8 days after diagnosis of sepsis could be used as prognostic indexes for severe burn patients with sepsis.
ABSTRACT
Objective To explore the preventive effect of low molecular weight heparin calcium in severe burn patients with venous thrombosis. Methods 64 patients of lower extremity burns complicated by systemic inflammatory response in Taizhou Enze medical center (Group) Enze hospital from March 2016 to 2017 March as the research object, were received once daily subcutaneous injection of 2850 U (0.3 mL) low molecular weight heparin calcium treatment, continuous injection of 10 d. The control group was given the routine nursing on the basis treatment, the observation group was given nursing intervention, the incidence rate of deep venous thrombosis and nursing satisfaction rate were compared between two groups. Methods FIB and blood D-dimer in the seventh day after treatment were improved (P<0.05) , PT and APTT in the seventh day after treatment were increased (P<0.05) , the level of FIB in the seventeenth day after treatment was significantly lower than the first day and the seventh day. The incidence of deep vein thrombosis in the observation group was significantly lower than the control group, nursing satisfaction rate in the observation group was higher than the control group, the difference was statistically significant (P<0.05). Conclusion Subcutaneous injection of low molecular weight heparin calcium in patients who are in high blood coagulation state after moderately severe burns SIRS can effectively prevent deep venous thrombosis, auxiliary nursing intervention is helpful to promote the rehabilitation of patients and improve nursing satisfaction.
ABSTRACT
Objective To explore the preventive effect of low molecular weight heparin calcium in severe burn patients with venous thrombosis. Methods 64 patients of lower extremity burns complicated by systemic inflammatory response in Taizhou Enze medical center (Group) Enze hospital from March 2016 to 2017 March as the research object, were received once daily subcutaneous injection of 2850 U (0.3 mL) low molecular weight heparin calcium treatment, continuous injection of 10 d. The control group was given the routine nursing on the basis treatment, the observation group was given nursing intervention, the incidence rate of deep venous thrombosis and nursing satisfaction rate were compared between two groups. Methods FIB and blood D-dimer in the seventh day after treatment were improved (P<0.05) , PT and APTT in the seventh day after treatment were increased (P<0.05) , the level of FIB in the seventeenth day after treatment was significantly lower than the first day and the seventh day. The incidence of deep vein thrombosis in the observation group was significantly lower than the control group, nursing satisfaction rate in the observation group was higher than the control group, the difference was statistically significant (P<0.05). Conclusion Subcutaneous injection of low molecular weight heparin calcium in patients who are in high blood coagulation state after moderately severe burns SIRS can effectively prevent deep venous thrombosis, auxiliary nursing intervention is helpful to promote the rehabilitation of patients and improve nursing satisfaction.
ABSTRACT
Objective To compare the effects of different moist environment for treating severely burned patients.Methods From November 2009 to December 2014 in the Burn Unit of Hainan General Hospital, 170 hospitalized patients with severe burns were randomly equally divided into observation group and control group.The patients of control group were treated with the traditional wet therapy treatment, while of the observation group were given the closed moist therapy treatment.The wound healing, pain relief and adverse reactions were observed.Results All patients completed the treatment,and the cure rates at the 7th and 14th day of treatment in the treatment group were 80.0％ (68/85) and 97.6％ (83/85), significantly higher than those of the control group (52.9％ (45/85), 89.4％ (76/85), x2 =8.344,4.111, P ＜ 0.05).The number of dressing changes((7.44±2.39) times), cumulative dressing time ((45.98 ± 13.29) min) and wound healing time ((14.98±4.33)d) in the observation group were significantly less than those in the control group((11.76 ±3.14) times, (87.03 ± 14.99) min), (18.87 ± 5.13) d)), the differences were statistically significant (t =6.349,6.540,3.111, P＜0.05).After treatment, the pain scores were showed clear downward trend, with had significant difference compared before treatment (P＜0.05), while the pain scores at the 7th day((3.10± 1.34) scores) and 14th day((1.76±0.67) scores) of treatment in the treatment group were significantly lower than the control group((4.09±0.89) scores, (3.11±0.56) scores, P＜0.05).The incidence of adverse events during treatment in both groups were 5.9％, obviously improved after symptomatic treatment.Conclusion The moist environment conducive to the treatment of severely burned patients, and safety.Conclusion to traditional wet therapy, closed moist therapy has better cure rate of severe burns, can promote wound healing, relieve pain and shorten the dressing cycle time.
ABSTRACT
Objective To investigate the effect of comprehensive nursing intervention and evaluate its role in the entire clinical course of in the treatment of children with severe burns. Methods A total of 60 children with 1-5 years old with clinical diagnosis of severe burns were randomly divided into experimental group and control group by random digits table method, 30 cases in each group. The control group received routine burn care. The experimental group received comprehensive nursing interventions on the basis of routine burn care and the intervention time covered the entire course of treatment. During hospitalization, the recovery and family social system were evaluated by anxiety scales and social support scales combined with the cure rate and hospitalization of children. Results Before intervention, the score of Anxiety Rating Scale was high in both groups of families, while Social Support Scale was lower, the difference was not statistically significant between the two groups (P>0.05). After intervention, the score of Anxiety Rating Scale and was Social Support Scale were (52.31±7.81), (31.52± 5.48)points in the experimental group, and (62.51 ± 6.52), (23.62 ± 5.62) points in the control group, and there were significant differences (t=5.491 3, 5.512 5, P<0.01). The length of stay was (18.34±3.58) d in the experimental group, and (21.82 ± 4.23) d in the control group, and there was significant difference(t=3.439 6, P<0.05). The cure rate was 93.33%(28/30) in the experimental group, and 56.67%(17/30) in the control group, and there was significant difference(χ2=10.755 6, P<0.05). Conclusions The comprehensive nursing intervention can provide comprehensive refinement of the overall care in children and their families, promote physical and psychological rehabilitation of children with severe burns, and repair their family and social support systems. The comprehensive nursing intervention has far-reaching implications for the rehabilitation of children with severe burns.
ABSTRACT
Objective To investigate the effect of glutamine on energy intake and prognosis of severe burn patients in differ-ent pathway.Methods Using retrospective study method,we brought the patients into our study from October 2010 to April 2014 in accordance with the inclusion criteria.Patients who were given the Gln before 5 days after injury through gastric bowel were brought into the EN group,others who were given the Gln after 5 days after the injury through vein were brought into PN groups. A total of 66 patients were included in this study,with 31 cases of EN group and 35 cases of PN group.Total energy intake,external and internal energy intake,nutrients heating,energy intake/energy consumption ratio,blood glucose control,insulin use and viscera damage(the blood urea nitrogen,creatinine,alanine aminotransferase,aspartate aminotransferase,total bilirubin,creatine kinase,lac-tate dehydrogenase),ICU days,hospital stays and mortality were observed in 1,2,3,4 weeks after injury.Results Within a month after the injury,the energy intake of patients in EN group were more than PN group,especially the energy from intestinal canal.Be-sides,the ICU days of patients in EN group were shorter than patients in PN group (all P 0.05).Conclusion Supplement of Gln may be more conducive to improve the intestinal function in patients with burns may be more conducive to improve the intestinal function in patients with burns,im-prove the degree of tolerance of enteral nutrition,increase energy intake and conducive to improving the prognosis of patients.
ABSTRACT
Objective To explore the current research status and existing problems in severe burn nursing by reviewing relevant literature of severe burn nursing published in 6 kinds of nursing core journals. Methods Search 6 kinds of nursing core journals using the following key words: severe burn critical burn serious burn large area burn intensive burn and nursing. Applying bibliometrics to conduct descriptive analysis of the external and internal characteristics of these papers. Results Two hundred and nine papers were included;the main literature research type of thess articles was clinical experience summary, the content of these literature was extensive. Conclusions Severe burn nursing research focus on clinical symptomatic nursing; clinical nurse scientific research ability needs to be strengthened, and subject aspects should be paid more attention to children, the elderly, and clinical nurse physical and psychological conditions.
ABSTRACT
Introducción: acorde con las investigaciones actuales con respecto al paciente con quemaduras, resulta de gran interés poder evaluar las alteraciones del estrés oxidativo en estos para buscar su vínculo con la fisiopatología de esta entidad nosológica y su posibilidad de establecer pronósticos de vida. Objetivo: evaluar el comportamiento de marcadores prooxidantes y antioxidantes de pacientes quemados mayores, e identificar la posible relación entre los valores de estos marcadores con el grupo en que se ubican los pacientes, dentro de la clasificación cubana de pronósticos de vida. Métodos: en una muestra de 15 pacientes, con quemaduras, distribuidos en: 6 graves, 6 muy graves y 3 críticos extremos, según la clasificación cubana de pronósticos de vida, se determinaron las concentraciones plasmáticas de malonildialdehído, superóxido dismutasa, catalasa y peroxidación lipídica, en las primeras 24 h, al sexto día y a los 21 días de recibida la lesión. Los datos se procesaron con el programa STATISTICA 6.1 Resultados: los valores de los marcadores variaron de forma patológica, con un nivel significativo entre cada momento estudiado. El estrés oxidativo en estos pacientes se instauró en las primeras horas de recibido el trauma y su comportamiento no dependió de la gravedad de los pacientes según la clasificación cubana de pronósticos de vida Conclusiones: el desbalance oxidativo que se produce en el paciente quemado abarca desde la fase de shock hipovolémico hasta la adaptación según la clasificación fisiopatológica de Kirsbaum. La variación de los marcadores de estrés oxidativo, no se comporta de forma homogénea dentro de los grupos de estudio de la clasificación cubana de pronósticos de vida
Introduction: according to current researches regarding the burnt patient, it is interesting to assess the oxidative stress alterations in them to seek its link with the physiopathologic features of this nosologic entity and its possibility to establish life prognosis. Objective: to assess the behavior of pro-oxidative and oxidative markers of patients with severe burns and to identify the possible relationship among the values of these markers with the group where the patients are located within a Cuban classification of life prognosis. Methods: sample included 15 burnt patients, distributed in: six severe, six very severe and three critically severe, according the Cuban classification of life prognosis, determining the plasma concentrations of malonyldialdehyde, superoxide, dismutase, catalase and lipid peroxidation during the first twenty four hours, at sixth day and at twenty one days after lesion. Data were processed using the STATISTICA 6.1 program. Results: marker's values changed the pathological way, with a significant level between each study moment. The oxidative stress in these patients appeared during the first hours after trauma and its behavior not depended on severity of patients according to the Cuban classification of the life prognosis. Conclusions: the oxidative lack of balanced present in the burnt patient covers from the phase of hypovolemic shock up to the adaptation according the Kirsbaum physiopathologic classification. The variation of the oxidative stress markers not behaves in a homogenous way in the study groups of the Cuban classification of life prognosis
Subject(s)
Humans , Male , Female , Catalase , Free Radicals , Glutathione , Oxidative Stress , Superoxide DismutaseABSTRACT
0.05).These findings indicate that severe burns can destroy the coupled phosphorylation in the mitochondria and impair their capability to produce ATP.Immediate fluid infusion after burns can protect the mitochondrial function effectively.
ABSTRACT
In order to study the mechanism of the barrier functional impairment-of gastric mucosa after burus, phosphorus or napalm 30% TBSA Ⅲ? burns was inflicted to rats and the osmolarity of hydrogen and chlorine ions of their gastric lavage fluid was determined. It was found the concentrations of the 2 ions in the lavage fluid decreased immediately after burn injury, reached the lowest point in the 5th hour postburn, and did not return to its preburn level even in the 72nd hour postburn.It is considered by the authors that the lowering of hydrogen and chlorine ions in the gastric lavage fluid after burns results from the reversed diffusion of the ions into the gastric mucosa since the stress reaction of the organism towards severe burns can impair the barrier function of the gastric musosa and the increase of hydrogen ions in gastric mucosa can aggravate the function impairment. In addition, phosphorus is a cytoplasm toxic. It can be rapidly absorbed through the cutaneous tissue of the burned area and carried to the gastric mucosa to intensify the mucosal lesion.
ABSTRACT
The dynamic changes of the transcriptional activities of the nuclei of the rat liver and skeletal muscle cells were observed in the 6th, 12th, 24th, 48th, and 72nd hours after the animals were inflicted with 30% TBSA third degree burns.It was found that the incorporation of [3H]-UTP into the liver cell nuclei in vitro increased significantly in the 6th and 12th postburn hours. The peak of elevation occurred in the 6th hour postburn (from 7408 ?690 cpm/50?g DNA of normal to 10175 ? 1227 cpm/50?g DNA, P