由一個黃磷彈爆炸的個案談目前燒傷治療的趨勢

一個十六歲因黃磷彈在雙手中爆炸，造成全身總面積40%三度燒傷及嚴重呼吸道灼傷的患者，經住院治療後產生了許多併發症，也引發一些爭議，我們將此個案的治療過程做一整理，並報告我們的心得及治療原則；我們的結論為：(1)磷彈爆炸的磷片須儘早移除，(2)對磷中毒，須儘早用calcium gluconate以降低毒性反應，(3)呼吸道灼傷並不需限制水分輸入，(4)有呼吸道灼傷時，血色素最好在十以上，以維持各器官之塞本氧氣供應，(5)傷口處理上仍以儘早切除及補皮為原則，(6)Integra及Alloderm用在燒傷傷口需護慎，(7)對極嚴重的呼吸道灼傷，其插管方式及材料選擇須謹慎，(8)在三度燒傷傷口上做氣切乃是可行的，但須有極積極負責的護理照顧，否則會有極嚴重的併發症，(9)對因眼瞼外翻而致眼球暴露者，可以厚厚的眼藥膏保護，須常更換眼藥膏，(10)手之四度燒傷治療原則。

關鍵字

燒傷；黃磷燒傷；呼吸道灼傷；燒傷治療

並列摘要

A case of a 16-year-old person with yellow-phosphorus blast injury was admitted to our burn center. 35% TBSA 3(superscript rd)-4(superscript th) degree burns and inhalation injury were noted. Multidisciplinary approaches were taken to treat multiple complications with a promising result. Our case of blast injury and phosphorus shows that (1) phosphorus should be removed as early as possible. (2) Calcium gluconate via continuous IV could improve the toxic reaction. (3) Fluid resuscitation should be adequate. Fluid limitation is not necessary even when there are pulmonary problems. (4) Since serum albumin is not a reliable indicator in burns, keeping hemoglobin＞l0g% is useful to maintain good organ perfusion and reduce interstitial tissue edema. (5) Wound excision should be performed as early as possible and be covered with autologous skin graft. (6) Current new dermis substitutes, like Integra or Alloderm, cannot be applied in case of wound sepsis (7) In case of aspiration of high irritalbe, corrosive, toxic gas, special attention should be paid to the tracheal tube to pervent complication, such as tracheal stenosis. (8) Tracheotomy over the burn site could be done, but it needs more delicate and aggressive nursing care. (9) If there is ectropion (eyeball exposure), eye ointment should be applied to fulfill the all orbital cavity and be changed every 2-3 hour until reconstructive surgery is performed. (10) Treatment of hand burn should follow our algorithm.

並列關鍵字

bruns ； phosphorus burn ； inhalation injury ； burn treatment

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由一個黃磷彈爆炸的個案談目前燒傷治療的趨勢

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