烧伤创面深度诊断技术的研究进展

刘一嘉; 吴鹏; 安纲; 方秋; 郑佳; 王一兵

doi:10.3760/cma.j.cn501120-20210518-00195

烧伤创面深度诊断技术的研究进展

doi: 10.3760/cma.j.cn501120-20210518-00195

刘一嘉¹,
吴鹏²,
安纲²,
方秋¹,
郑佳¹,
王一兵^2,, ,

1.
山东中医药大学第一临床医学院，济南　　250061
2.
山东第一医科大学第一附属医院（山东省千佛山医院）整形外科，济南市组织工程皮肤再生与创面修复临床医学研究中心，济南　　250014

基金项目:

山东省重点研发计划 2019GSF108128

山东省自然科学基金重大基础研究项目 ZR2019ZD38

详细信息

通讯作者:
王一兵，Email：wyb0616@163.com

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出版历程
- 收稿日期: 2021-05-18
- 网络出版日期: 2022-07-20
- 刊出日期: 2022-05-20

Research advances on the techniques for diagnosing burn wound depth

Liu Yijia¹,
Wu Peng²,
An Gang²,
Fang Qiu¹,
Zheng Jia¹,
Wang Yibing^{2,
, ,}

1.
The First Clinical Medical College,Shandong University of Traditional Chinese Medicine, Jinan 250061, China
2.
Department of Plastic Surgery, the First Affiliated Hospital (Shandong Provincial Qianfoshan Hospital), Shandong First Medical University, Jinan Clinical Medicine Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Jinan 250014, China

Funds:

Key Research and Development Program of Shandong Province of China 2019GSF108128

Major Basic Research Project of Shandong Provincial Natural Science Foundation of China ZR2019ZD38

More Information

Corresponding author: Wang Yibing, Email: wyb0616@163.com

摘要

摘要: 烧伤创面深度的准确诊断对评估烧伤患者病情的预后尤为重要，以往对于烧伤创面深度的诊断常依赖医师的主观判断，随着诊断技术的不断发展，烧伤创面深度的判定手段也获得了更新。该文主要汇总了吲哚菁绿血管造影、激光多普勒成像、激光散斑衬比成像和人工智能等技术在烧伤创面深度诊断中的应用研究进展，并比较这些技术的优点与不足，为烧伤创面深度的精确诊断提供思路。
- 烧伤 /
- 诊断 /
- 人工智能 /
- 创面深度 /
- 吲哚菁绿血管造影 /
- 激光多普勒成像 /
- 激光散斑衬比成像
Abstract: The accurate diagnosis of burn wound depth is particularly important for evaluating the disease prognosis of burn patients. In the past, the diagnosis of burn wound depth often relied on the subjective judgment of doctors. With the continuous development of diagnostic technology, the methods for judging the depth of burn wound have also been updated. This paper mainly summarizes the research progress in the applications of indocyanine green angiography, laser Doppler imaging, laser speckle contrast imaging, and artificial intelligence in the diagnosis of burn wound depth, and compares the advantages and disadvantages of these techniques, so as to provide ideas for accurate diagnosis of burn wound depth.
- Burns /
- Diagnosis /
- Artificial intelligence /
- Wound depth /
- Indocyanine green angiography /
- Laser Doppler imaging /
- Laser speckle contrast imaging
所有作者均声明不存在利益冲突

早期急性肾损伤（AKI）是严重烧伤患者常见的致命并发症。尽管近年来在液体复苏、重症监护和肾替代治疗（RRT）技术方面取得了显著进展，但严重烧伤AKI患者的发病率和病死率仍然相当高。作者对危重烧伤患者进行3年的单中心回顾性研究。纳入年龄在18岁以上、烧伤总面积≥30%TBSA的患者，观察到早期AKI的发生率与烧伤总面积、Ⅲ度烧伤面积、入院时简明烧伤严重指数（ABSI）、吸入性损伤、机械通气、心血管并发症和横纹肌溶解有关。多元logistic回归分析显示，烧伤总面积（比值比=0.224, P=0.007）、Ⅲ度烧伤面积（比值比=0.254, P=0.014）、ABSI（比值比=18.326, P=0.009）、横纹肌溶解（比值比=24.036, P=0.000）是发生早期AKI的独立危险因素。影响早期AKI严重程度的重要因素包括Ⅲ度烧伤、电烧伤和横纹肌溶解，Ⅲ度烧伤面积（比值比=1.437, P=0.041）和横纹肌溶解（比值比=5.401, P=0.035）也与患者病死率相关。在Cox模型中，经烧伤总面积、Ⅲ度烧伤面积、ABSI和横纹肌溶解校正后，AKI发生的死亡风险为5.407。死亡的3例患者均为AKI 3期，占AKI患者的8.3%（3/36）。接受和未接受早期RRT的3期AKI患者的病死率分别为33.3%和66.7%。该文结论：横纹肌溶解是危重烧伤患者发生早期AKI的独立危险因素，与烧伤严重程度密切相关；重度烧伤患者早期AKI发生率较高，但多为轻度；早期充分的液体复苏，及时有效的焦痂切开减张术，可降低横纹肌溶解的发生率和严重程度，多数可达到较好的预后。

李江锋，编译自《Burns》,2020，46(5):1100-1106；郇京宁，审校

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