| Background:Burn is one of the most common accidents in children at present.Because of their age characteristics and range of activities are greatly different from adults,hydrothermal burns are more common in children’s daily life,and others are flame burns,electric burns and burns caused by other reasons.Infantile burn s usually occur in early childhood and early school age,and the degree of burns is closely related to the temperature of heat source and the length of contact time,and is also related to the more tender skin of children than adults and their failure to get away from the cause of injury in time.Therefore,under the same conditions,the degree of injury of children burns is much more serious than that of adults.Burn shock is a complex systemic pathophysiological process and clinical comprehensive symptom that appears early after severe burn and affects the whole process of disease development and treatment results.Whether the children can survive the shock phase smoothly directly affects the effect of the whole treatment.Fluid resuscitation is still an important method for early treatment of severe burn patients.Therefore,timely and effective fluid resuscitation treatment in shock period is crucial for preventing complications and improving the cure rate of children with severe burn,and plays a positive role in improving the treatment level of severe burned children.Objectives:The purpose of this study was to provide reference and experience summary for improving the treatment level of fluid resuscitation during shock period,reducing the incidence of complications and improving the prognosis of children with severe burns by collecting the medical records of children with severe and extremely severe burns admitted to Shandong Provincial Hospital from May 1990 to August 2019,analyzing and discussing their treatment of fluid resuscitation in the shock period,and studying the factors affecting the length of stay and complications of them.Methods:the clinical data of children with severe and extremely severe burns admitted to Shandong Provincial Hospital from May 1990 to August 2019 were retrospectively analyzed.After admission,all children received general treatment and fluid resuscitation treatment in time,and other adjuvant treatments were also given.Research and analysis of the general information of all children included in this study(including gender,age,weight,date of admission,season,causes,burned part of body,burn area,whether with inhalation injury,time duration to hospital after injuries,number of operations,the length of stay,patient outcome,complications,etc.),The fluid rehydration status and vital signs monitoring data(including heart rate,respiration,oxygen saturation,urine volume,etc.)as well as other treatment conditions during the first 24hour and the second 24hour.The actual amount of each component and total amount of rehydration were compared with the corresponding theoretical amount calculated according to the national general formula of rehydration,and the risk factors related to the length of stay and complications were explored and screened by regression analysis.SPSS26.0 software was used for data processing and statistical analysis in this study.The Wilcoxon rank sum test,Mann-Whitney U test,Kruskal-Wallis H test and Pearson chi-square test were used for the study of fluid rehydration within 48 hours after injury.Fisher’s exact test was used if the theoretical frequency was less than 5 in the chi-square test.Univariate and multivariate linear regression methods were used to analyze the factors affecting the LOS of children with severe burns,and univariate and multivariate Logistic regression methods were used to analyze the risk factors related to complications.P<0.05 was statistically significant.Results:1.Medical records of 117 eligible children were included in this study,including 72 males and 45 females,with a male-to-female ratio of 1.6:1.The age distribution ranged from 1 to 12 years old with a median age of 2(1,3)years old.Four cases(3.42%)were associated with inhalation injury on admission.The median time duration to hospital after injuries was 3(1,5)hours.The median LOS was 22(14.5,34.5)days.The most common burn parts of children were limbs and trunk.Hydrothermal scald is the main injurious factor.The total burn area ranged from 16%to 90%,and the median total burn area was 25(20,30)%.The median ABSI was 4(4,5),the median BI was 12.5(10,16.5),and the median Baux score was 26(21,33).2.In all children,the actual input of water,colloid,and total fluid at the first 24h and the second 24h after injury were significantly less than the theoretical amount,and the actual input of crystal amount was significantly more than the theoretical amount,P<0.001;In the first 24 hours,111 cases of the 117 children maintained satisfactory urine output,while 6 cases still could not reach 1ml/kg/h.The urine output of all children reached more than 1ml/kg/h by the second 24h.After rehydration treatment in shock period,the mean urine output in the second 24h was significantly higher than that in the first 24h,P<0.001.3.Linear regression analysis showed that the proportion of Ⅲ° burn area,the failure of vital signs to meet the criteria at 48 hours after injury,the number of operations and the patient outcome were independent factors affecting the LOS of children with severe burn(P<0.05).For children with severe burns,the larger the proportion of the area of Ⅲ° burn,the more times of operation during treatment and the better outcome at discharge would result in the longer hospital stay.The LOS of children whose vital signs failed to meet the criteria was longer than that of children whose vital signs succeed to meet the criteria at 48 hours after injury.4.Logistic regression analysis showed that time duration to the hospital after injury,TBSA,the proportion of Ⅲ° burn area and the failure of vital signs to meet the criteria at 48 hours after injury were independent risk factors for complications in children with severe burns(P<0.05).For children with severe burns,the OR(95%CI)of complications was 1.385(1.040-1.844)for each additional hour of time duration to the hospital after injury.The OR(95%CI)of complications was 1.083(1.026-1.143)for each 1%increase of TBSA.The OR(95%CI)of complications was 1.036(1.000-1.073)for each 1%increase of the proportion of Ⅲ° burn area.Relative to the children whose vital signs succeed to meet the criteria at 48 hours after injury,the OR(95%CI)of complications in children whose vital signs failed to meet the criteria was 5.067(1.202-21.359).Conclusions:1.Early fluid resuscitation for severe burned children should take the calculation amount of the rehydration formula as a reference and to be adjusted according to the clinical presentation and monitoring indicators.To increase the input amount of electrolyte,reduce the input amount of water,in order to avoid a large input amount of water in short time,to reduce the occurrence of complications and help children with severe burn getting through the shock stage more smoothly.2.For children with severe burns,we could help them to pass through the shock phase more smoothly by paying more attention to the proportion of Ⅲ° burn area,close monitoring,and flexible,individualized rehydration therapy,carefully select surgery during treatment,and reduce the expectation of treatment outcome(such as transferring back to the local hospital or outpatient treatment when most of the wound healing,not having to wait until the wound is fully healed before leaving hospital),to shorten the LOS of them.3.Children with severe burns should go to a regular hospital for medical treatment in time to reduce the delay of the condition.In combination with the type of injury,time duration to the hospital after injury,TBSA and the proportion of the Ⅲ° burn area,the admission condition of the children with severe burns was accurately evaluated.Close monitoring and flexible,individualized treatment enable the children to get through the shock phase more smoothly,to reduce the incidence of complications and improve the treatment level of the children with severe burns. |
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