Early Factors for Predicting Mortality Rate in Major Burn Patients-China Medical University Hospital Experiences

重度燒傷患者死亡率的早期預測因子─中國醫藥大學附設醫院經驗

施秉庚(Pin-Keng Shih) ； 吳肇毅(Chao-I Wu) ； 張家寧(Sophia Chia-Ning Chang) ； 陳信翰(Hsin-Han Chen)

《臺灣整形外科醫學會雜誌》 22卷2期 (2013/06) Pp. 117-124

摘要

背景：許多研究提供了不同的參數來預測燒傷患者的死亡率，然而，所選定的參數較少集中受傷後的最初24小時中。目的及目標：在這項研究中，我們打算找出有意義的初期因子以預測大面積燒傷患者早期死亡率。材料及方法：一篇從2007年1月至2011年6月將大面積燒傷患者（大於20％體表面積）所進行的回朔性分析。相關變數分為生化及臨床因子：生化因素包括最初24小時內血漿中的鈉、鉀、鈣、磷、鎂離子和白蛋白；臨床因子包括燒傷面積（％）、年齡、性別，吸入性傷害，氣管插管、頭/頸部受創、糖尿病、高血壓、吸煙的習慣，再根據他們的預後，患者分為非倖存者和倖存者兩組。卡方檢定用於確定兩組於性別、吸入性損傷、氣管插管、頭/頸部受損、糖尿病、高血壓和吸煙之間是否有差異；Mann-Whitney檢驗則用於確認剩餘參數於兩組之間的差異性。任何參數有統計學上顯著意義更進一步以ROC 曲線分析。結果：45例患者分為兩組：非倖存者（N = 10）和倖存者（N = 35）。非倖存者組與倖存者組相比，有顯著更高的年齡，更高受損的體表面積和較低的血清白蛋白值。大面積燒傷患者氣管插管，吸入性損傷，頭/頸部受損與死亡率密切相關。ROC曲線分析顯示：體表面積（界限值：46.5％，敏感性100％，特異性為：94.12％）和血清白蛋白值（界限值：1.85，敏感性88.24％，特異性為90％）皆為預測死亡率良好的預測因子。結論：受損的體表面積和初步24小時血清白蛋白值對大面積燒傷患者死亡率為很好的預測因子，此外，大面積燒傷患者併氣管插管、吸入性損傷、頭部/頸部受損與死亡率密切相關。

並列摘要

Background:Background: Many studies have provided different parameters to predict the mortality rate in burn patients. However, the timing point is less focused on the parameters in the first 24 hours after injury.Aim and Objectives:We intended to find out the meaning of early predictors for mortality rates in major burn patients.Materials and Methods:A retrospective study from January 2007 to June 2011 of major burn patients (＞ 20% TBSA) was performed. Variables were divided into biochemical and clinical factors. The biochemical factors including serum sodium (Na), potassium (K), calcium (Ca), phosphate (P), magnesium (Mg)and albumin in the first 24 hours, and the clinical factors including TBSA (%), age, gender, inhalation injury, intubation, head/neck involvement, diabetes mellitus, hypertension, smoking were recorded. According to their outcome, the patients were divided into two groups: the non-survivors and the survivors groups. Chi-square test was used to determine the differences between two groups in gender, inhalation injury, intubation, head/neck involvement, diabetes mellitus, hypertension, and smoking. The Mann-Whitney test was used to determine the differences between the two groups in other parameters. Any statistically significantly parameters were analyzed by receiver-operating characteristic (ROC) curve.Results:Forty-five patients were divided into two groups: non-survivors (N=10) and survivors (N=35). Compared with the survivors group, the non-survivors group had significantly higher age, TBSA and lower serum albumin level. Major burn patients with intubation, inhalation injury and head/neck involvement were closely related to mortality. The ROC curve analysis showed TBSA (cut-off value: 46.5%, sensitivity: 100%, specificity: 94.12%) and serum albumin level (cut-off value: 1.85, sensitivity: 88.24%, specificity: 90%) were good predictors for mortality rate.Conclusion:TBSA and serum albumin level measures in the first 24 hours are good predictors for mortality rate in our burn center. Major burn patients with intubation, inhalation injury and head/neck involvement were closely related to mortality

並列關鍵字

serum albumin level ； receiver-operating characteristic (ROC) curve