Patients with Chemical Burns in a Single Burn Center
林敬鈞(Ching-Chun Lin)；楊瑞永(Jui-Yung Yang)；黃俊源(Chun-Yuan Huang)；莊秀樹(Shiow-Shun Chuang)
chemical burn ； ocular burn ； amniotic membrane
|Volume or Term/Year and Month of Publication||
18卷1期（2009 / 03 / 01）
35 - 42
背景： 化學性灼傷似乎比其他種類的灼燙傷要來得少見及不常被轉介，並且比其他種類的灼燙傷要來得容易被忽略。 目標及目的： 這篇文章是要呈現一個單一灼傷中心從西元1986年至2005年來二十年之化學性灼傷的統計資料和分析成果。 材料及方法： 從西元1986年5月至2005年5月間，364位化學性灼傷的病人住進林口長庚灼傷中心，並且被納入這個回溯性研究。 成果： 在這個研究中有289位男性及75位女性，男女比例是3.85比1。病人的平均年齡是33.9歲。病人的平均灼傷面積是11.2%(1-70%)，平均住院天數是19.3天。最常見的原因是職業傷害(68.7%)，第二常見的是潑灑侵襲(21.2%)。由強酸造成的化學性灼傷占65.7%，主要是由硫酸(33.5%)造成的。相反的，由強鹼造成的化學性灼傷占15.4%，主要是由氫氧化鈉(7.4%)造成的。在近十年來的主要化學性灼傷原因、病人數及嚴重度（平均灼傷面積和平均住院天數）都是呈現一個下降的趨勢，特別是在平均住院天數是有顯著差異的。臉部是最容易受傷的區域(59.6%)，而第二容易受傷的地方則是四肢。手部的化學性灼傷在職業傷害中顯著地較多(P=0.009)；反之，在潑灑侵襲的病人中則以臉部(P=0.000)、頸部(P=0.000)和胸部較多(P=0.000)並有顯著差異。眼灼傷則是最常見的伴隨性傷害占14.6%。 結論： 立即且適當地用大量的清水沖洗灼傷部位（尤其是眼部）仍是可以減少化學性灼傷的程度和減輕住院天數的標準處置方式。幾乎所有化學性灼傷的病人都被建議住院以接受進一步的傷口照護或是手術治療。近十年來，病人數、平均灼傷面積和平均住院天數都有下降的趨勢是一個好消息，因此積極且適當的安全教育及職業訓練，防護衣的使用，公權力的提升及降低犯罪率和建立更專業化的灼傷中心可以降低化學性灼傷的發生率和嚴重度。
Background: Chemical burn seems to be either much less uncommon or less under-referred than other types of burn injuries and is easy neglected than other types of burns. Aim and Objectives: This article presents the demographics and results of three hundred sixty-four patients of chemical burn admitted in single center. Materials and Methods: The above-mentioned patients were all admitted to and treated at Linkou Burn Center, Chang Gung Memorial Hospital from May, 1986 to May, 2005. Results: There were 289 males and 75 females, with a ratio of 3.85:1. The mean age of the patients was 33.9 years old. The mean burn size was 11.2% total burn surface area (TBSA) (1-70%) and the mean length of hospital stay was 19.3 days. Most common cause was occupational injury (68.7%), with the second was assault injury (21.2%). Strong acids causing burns (65.7%) were mainly sulfuric acid (33.5%). In contrast, alkali-caused burns (15.4%) were mainly by sodium hydroxide (7.4%). The distributions in main chemical burn causes, patient numbers and severity (mean burn size and mean length of admission) in recent 10 years presented a tendency of declining, especially the distribution in mean hospital day was significant different. (P=0.011＜0.05). The face (59.6%) was the most frequently injured area, with the second being extremities. The hand involvement rate P=0.009) is significantly higher in the occupational group, rather the injury rates of face (P=0.000), neck (P=0.000) and chest (P=0.000) were significantly higher in the assault group. Ocular burn was the most common accompanying injury (14.6%). Conclusion: Adequate irrigation of the burnsite immediately with large volumes of water (especially for eyes) is still the standard management to reduce the severity of chemical burns and reduce the hospitalization days. Almost all of the chemical burn patients are suggested to admit for further wound management or surgical interventions. It is good news that the patients numbers, mean burn area and mean hospital day of chemical burn declined in recent 10 years, therefore the intensive and adequate safety education and professional training, usage of protective clothing at workplace, advancing of public authority elevation and changing criminal way and establishing more specialized burn centers in each medical center are recommended to reduce the incidence and severity of chemical burns.