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目的探寻烧伤严重程度分度的新方法。方法选取笔者单位1958年12月—2004年12月收治的有烧伤面积记录的单纯烧伤患者,用同病死率(病死率取0.5%)法确定烧伤患者的年龄分组。根据组内细分的各面积单元组病死率的统计学差异及临床情况,把各年龄组内患者烧伤程度划分为4度:轻、中、重、特重度。统计组内各烧伤程度对应的烧伤总面积范围、例数、病死率范围和Ⅲ度面积范围,将烧伤总面积范围和Ⅲ度面积范围作为各年龄组烧伤程度的面积分度标准。以患者病死概率为应变量,年龄、烧伤总面积、各种深度的烧伤面积为协变量建立Logistic回归模型。用该模型预测笔者单位2005年收治的患者病死概率,核对患者相关指标与前述分度标准是否符合;判断合并有吸入性损伤、严重合并伤或伤前重大疾病患者的烧伤严重程度。结果患者年龄最终分组为≤2岁、>2岁且≤55岁、>55岁。各组内烧伤程度的面积分度标准详见正文表2,Logistic回归模型为P(病死概率)=1÷[1+e~(-5.666-0.014×年龄+0.041×烧伤总面积+0.027×深Ⅱ度面积+0.060×Ⅲ度面积],该方程预测的病死概率及相关指标与该分度标准符合率较高。有中度以上吸入性损伤患者可直接定为重度或特重度烧伤,仅有轻度吸入性损伤者依面积标准界定烧伤严重程度。结论Logistic回归模型预测的病死概率可作为判断烧伤严重程度的良好指标,前述年龄分组较合理,对应的烧伤程度分度标准较为准确、实用。
Objective To explore a new method of indexing the severity of burn injury. Methods The patients with simple burns recorded from December 1958 to December 2004 with burn area records were selected to determine the age group of burn patients with the same case fatality rate (0.5% mortality). According to the group of subdivided the unit area of each group of fatality rate of statistical differences and clinical conditions, the degree of burn in patients within each age group is divided into 4 degrees: light, medium, heavy and extraordinarily severe. The total burns area, the number of cases, the fatality rate range and the third degree area range corresponding to the degrees of burns in the statistical group are taken as the area standard for the degree of burns in each age group. Logistic regression model was established based on the probability of patient’s death as the dependent variable, the age, the total area of burns and the burn area of various depths as covariates. The model was used to predict the death probability of patients treated by the author in 2005 and to check whether the relevant indexes of patients were consistent with the above criteria. The severity of the burn was evaluated in patients with inhalation injury, severe combined injury or major diseases before injury. Results Patients were finally grouped as ≤2 years old,> 2 years old and ≤55 years old,> 55 years old. The scale of burn in each group is shown in Table 2. Logistic regression model is P (mortality probability) = 1 ÷ [1 + e ~ (-5.666-0.014 × age + 0.041 × total area of burns + 0.027 × depth Ⅱ degree area + 0.060 × Ⅲ degree area], the equation predicting the probability of death and related indicators with the indexing standard coincidence rate higher than those with moderate or more inhalation injury can be directly set as severe or severe burn, only Mild inhalation injury according to the area standard to define the severity of the burn.Conclusion The mortality predicted by Logistic regression model can be used as a good indicator of the severity of the burn, the above age group is more reasonable, the corresponding degree of burn index is more accurate and practical.