外科学烧伤汉英双语教学课件

1、BURNS烧伤Li aoSheng ZhiyongXia Zhaofan1958 Burn unit Shanghai/Beijing/Chongqing etc.The Chinese Academy of EngineeringYou？History of Burns in China 中国烧伤科发展史1983 CBA(Chinese Burn Association）1959 Spring Reigns Everywhere Baiyang A BOOK,A US TV SeriesTeaching Requirements 教学要求 To Grasp 掌握 Estimation of

2、burn area 烧伤面积估测 Judgement of burn depth and severity 评价烧伤深度和严重度Clinical manifestation , diagnosis and fluid resuscitation of burn shock 烧伤性休克的临床表现、诊断和体液补充 The principle of treatment on burn wound 烧伤创面的治疗原则 To Understand 理解Pathophysiology and clinical stages 病理生理及临床分期The mechanism of injury on elect

3、ric and chemical burn 电烧伤和化学性烧伤的损伤机理To Acquaint 熟悉Clinical manifestation and prevention of burn infection 烧伤感染的临床表现及预防The mechanism of injury, clinical manifestation, diagnosis and treatment of inhalation injury 吸入性烧伤的损伤机理、临床表现、诊断和治疗The principle of treatment on electric and chemical burn 电烧伤和化学性烧伤的

4、治疗原则 The Incidence of Burns 烧伤的发生率： 3-5% surgical inpatients 外科住院患者 Introduction 简介Thermal burns 热灼伤Scald and flame burns 烧烫伤Unexpected Events 突发事件(Social Development and Stable)Unexpected Events 突发事件(Social Development and Stable)2014 Kunshan2010 Shanghai2009 ChengduInjury Area 损伤范围Large area burn

5、大面积烧伤Systemic reactions 全身反应Local lesions 局部损伤Small area burn 小面积烧伤. Thermal Burn 热灼伤 Heat 高温 Burn 烧伤Hot oilHot metal SteamFlameContinuouslow temperature burnA females whole body surface areaThe largest organ 最大的器官The Skin 皮肤 The structure 结构 FunctionEpidermis 表皮Dermis 真皮Subcutis 皮下组织Burn severity 烧

6、伤严重度?Therapy 治疗 Burn area 烧伤区域Burn depth 烧伤深度 Estimation of Burn Area 估测烧伤面积 %Total Body Surface Area 全身表面积(%TBSA) Rule of nine 九分法 Rule of palm 掌分法9%9%9%9%9%9%13%+13%+1%13%+13%+1%21%21%13%13%5%6%7%6%Chinese rules of 9s 中国的九分判断法(Adult)Chinese Pithy Formula 中国计算公式口 诀三三三五六七前后十三下面一屁股“五”热得脚“七”小腿十三大二一1个9

7、2个93个95个9+1%Facial and neck 颈部 area(%)：9（12age）Chinese Rules of 9s (Child)Buttocks 臀部 and legs and feet area (%)：46（12age）2. Estimation of burn area using rule of a palm 使用手掌估测规则估计烧伤区域The hand palm= TBSA 1% Judgement of Burn Depth 判断烧伤深度 Three degrees and four classifications 三级和四级分类法 First degree b

8、urnSecond degree burnDeep second degree burnThird degree burnFirst Degree Burn 一度烧伤(Erythematous红斑)Red, slight swelling, pain, no blister 红、肿、痛、无水泡No trace 无痕迹3-7 daysSecond Degree Burn 二度烧伤(Blister 水泡) Big blister, swelling, extremely painful 大水泡、肿胀、极度疼痛Texture 质地: red, wet 红、湿7-14 days No permanen

9、t trace 无永久性痕迹Deep Second Degree Burn 深二度烧伤White-red(mottled), wet, swelling,pain, less and little blister 白-红（有杂色）、湿润、肿胀、疼痛、水泡少而小3-4 weeks Scars, pigmentations 疤痕、色素沉积Third Degree Burn 三度烧伤(Eschar 焦痂)white, tan, or eschar, thrombosed veins, leathery, painless 白色、褐色或形成焦痂、血栓静脉形成、皮革样、无痛operations Scar

10、s, contracture deformity 疤痕、挛缩畸形Summary of Burn Depth BurndepthPathologicalchanges Clinic featuresHealingtimeOutcomeFirstdegreeepidermis (parts layers)Color: redTexture: slight swelling, no blister Feeling: pain1 weekno traceSeconddegree epidermisdermis(upper layers )Color: redTexture: big blisters,

11、 swellingFeeling: extremely painful1-2weeksno traceDeepsecond degreeepidermis,dermis( most layers)Color: white-pink/redTexture: swelling, less blisterFeeling: pain3-4weeksscarsThirddegree all layers of skin, muscle,boneColor: white, tan, eschar, Texture: leathery, non-elasticFeeling: painless operat

12、ionscars烧伤深度总结 烧伤深度病理改变临床特征康复时间结局一度表皮 (部分层)颜色: 红质地: 轻度肿胀、无水泡感觉: 疼痛1 周无痕迹二度表皮真皮(上层)颜色: 红质地: 大水泡、肿胀感觉: 极度疼痛1-2 周无痕迹深二度表皮真皮(多数层)颜色: 白-粉/红质地: 肿胀、少水泡感觉: 疼痛3-4 周疤痕三度皮肤全层肌肉骨颜色: 白、褐、焦痂质地: 皮革样、无弹性感觉: 无痛需手术疤痕 “Fourdegrees， five classifications 四度五分法” ： 浅 深 ：Under deep fascia 深筋膜下The Judgment of Burn Severity

13、判断烧伤严重程度Burn area, depth, position, patients age, associated injury, physical strength, visceral organic disease, etc. 烧伤面积、深度、位置、患者年龄、合并损伤、体力、内脏器官疾病等 Classification of Burn Severity TBSA% 。TBSA%Mild burns： 10 。 Moderate burns： 1130 or 10Severe burns： 3150 or 1120 50 or 20 shock, combined injury, in

14、halation injuryThe Judgment of Burn Severity 判断烧伤严重程度Burn area, depth, position, patients age, associated injury, physical strength, visceral organic disease, etc. 烧伤面积、深度、位置、患者年龄、合并损伤、体力、内脏器官疾病等 烧伤严重程度分类 TBSA% 。TBSA%轻度烧伤： 10 。 中度烧伤： 1130 or 10重度烧伤： 3150 or 1120 50 or 20 休克、合并损伤、吸入性损伤Inhalation Inju

15、ry 吸入性损伤The mechanism of inhalation 吸入性损伤机理：Flame, Steam, Poison gas 火焰、蒸汽、毒气- Respiratory passage 呼吸道Keys 要点:Medical history, Cause of injury 病史、伤害原因Attention 注意:High death rate 高死亡率(Asphyxia 窒息), Combined injury 合并损伤Inhalation Injury Classification 吸入性损伤分类Extent of diseaseClinical manifestationTre

16、atmentMildNose, Mouth,Pharynx Rhinothrix burn, Trachyphonia, Irritating cough, DysphagiaSymptomatic treatment， Oxygen uptakeModerateAdd throat, TracheaAdd AWO(airway obstruction), Difficult breathingTracheotomy, Atomize inhalationSevereAdd bronchus，Pulmonary alveoli Appear early, Add moist rales, Tr

17、acheotomy, Atomize inhalationInhalation Injury Classification 吸入性损伤分类患病范围临床表现治疗轻度鼻、口腔、咽鼻毛烧伤、声嘶、刺激性咳嗽、吞咽困难对症治疗、吸氧中度+喉、气管+AWO(气道阻塞)、呼吸困难气管切开术、雾化吸入重度+支气管、肺泡早期发作、 +湿啰音气管切开术、雾化吸入MildModerateSevereTracheotomy 气管切开术Percutaneous Tracheotomy 经皮气管切开术1. the Acute Phase of Exudation 急性期渗液(Shock Stage 休克期)Body f

18、luid exude 体液渗出Acute Phase of Exudation 急性期渗液Characteristics, Attention 特点、注意事项Hypovolemic Shock 低血容量性休克, 48Hthe Clinical Courses of Burn 烧伤的临床表现2. Infective Stage 感染期 Characteristics 特征Infection from wound surface 伤口表面感染Enterogenic infection 肠源性感染Attention 注意- Septicemia 败血症Severity of Burn 烧伤严重程度,

19、 Whole body 全身intestinal tract3. the Repairing Stage 修复期The time node of repairing period after burn 烧伤后位于修复期的时间节点（？）Scar formation and treatment during repairing period 修复期疤痕形成和治疗Wound closure 伤口闭合, Excision of eschar焦痂切除术(Early, Large area 早期、大面积)4. The Rehabilitation Stage 康复期the Idea of Integrat

20、ion 一体化理念: Early Treatment+ Rehabilitation 早期治疗+康复Residual wound 残余创面Scar contracture 疤痕挛缩Scar deformity 疤痕畸形Psychological counseling 心理咨询Principles of Treatment after Burns 烧伤后治疗原则Small areas and superficial burn 小面积和表面烧伤： Wounds 伤口- Self-healing, Operation 自愈、手术Large area and deep burn 大面积和深度烧伤： S

21、hock 休克- Fluid infusion 补液 Infection 感染- Antibiotics 抗生素 Wound 伤口- Operation 手术 Rehabilitation 康复- Integration concept 整合观念 Inhalation injury 吸入性损伤- Respiratory tract 呼吸道Organs 器官MODSFirst Aid，Transportation and Prime Treatment 急救、运输和主要治疗First Aid 急救Cooling, Protecting Wound 冷却、保护伤口Transportation 运输

22、Short 短、Fast 快、Steady 稳固、System 系统Prime treatment 主要治疗Mild 轻度Wound 伤口Moderate 中度/Severe 重度/Major 极重度Systemic therapy 全身治疗 Burn Shock 烧伤性休克Characteristics 特征Hypovolemic shock 低血容量性休克 Plasma lossing 血浆丢失Continues loss, and slow 持续、缓慢丢失Burn area 烧伤面积15%TBSA(Adult) 5%TBSA(Child) Clinical Features 临床表现Ur

23、ine reduce 尿量减少：Adult20ml/h，Child120/minThirsty 口渴Agitating 焦虑Vomiting 呕吐Poor peripheral circulation 外周循环不良BP 血压- Decreasing 降低, Pulse Differential Presssure 脉压差30mmHgOxygen saturation 血氧饱和度- Decreasing 降低Laboratory Test 实验室检测：Hematocrit 血细胞比容(HCT)- Increasing 升高 Burn Shock Treatment 烧伤性休克治疗Adult 成人

24、 1st 24h Infusion volume 输液量:1TBSA(、), Colloid 胶体(0.5)+Electrolyte 电解质(1.0)1.5ml/kg+Base water 基础水2000ml;Electrolyte 电解质:Colloid 胶体- 2:1，1:1;Infusion Speed 输液速度: of total volume 8h， of total volume 8-24h； 2nd 24h Infusion volume 输液量： of 1st Colloid 胶体； of 1st Electolyte 电解质;Base water 基础水2000ml;Flui

25、d to prevent burn shock 输液防止烧伤性休克:Colloid 胶体: Plasma 血浆, Blood 血液, Dextran 右旋糖酐, Gelofusine佳乐施（血定安）;Electrolyte 电解质: Balanced Salt Solution 平衡盐溶液, 0.9%NaCl;2 (Saline 生理盐水) + 1(1.25% Dicarbonate 小苏打); Alkalize urine 碱化尿液Base water 基础水: 5/10 Glucose Injection 葡萄糖注射液;Q: An adult patient,50%TBSA(+), Wei

26、ght:60kg, How to calculate the Fluid infusion 如何计算输液量? Child 儿童2YElectrolyte 电解质: Colloid 胶体：1:1；Total volume 总容积：%TBSAweight(kg)1.75；Base water 基础水：50100ml/(kg.d) How to judge the burn shock 如何判断烧伤性休克:Quiet Patient 病人安静(Coma 昏迷?);Peripheral vein 周围静脉;Urine 尿量:1ml/kg.h;Pulse 脉搏:5cmH2OL.T 实验室检查：Hct 血

27、细胞比容, Blood Gas Analysis 血气分析(Acidosis 酸中毒);Smooth and steady breath 呼吸平稳顺畅;Burn Infection 烧伤感染Invade ways 入侵途径Wound 伤口 Enterogenic infection 肠源性感染Inhalation 吸入性- Respiratory system 呼吸系统IatrogenicInfection 医源性感染: Venipuncture 静脉穿刺Clinical Features of Burn Infection 烧伤感染的临床表现Body temperature 体温:39/36

28、.5 Agitating 焦虑, Coma 昏迷, Slow 缓慢/Rapid 急速 breathing, Abdominal distension 腹胀Bad wound surface 伤口表面变质: Granulation 粗糙, Necrotic tissue 坏死组织Inflammatoryreaction 炎症反应, Skin-autopepsia 皮肤自溶Shock 休克- Infection shock 感染性休克Infected Wound Surface 伤口表面感染To prevent infection 预防感染Early treatment 早期治疗, Prevent

29、 shock 预防休克Wound treatment 创面治疗Intelligent use antibiotics 合理使用抗生素Nutrition and surpport therapy 营养和支持疗法Key Organs 重要器官: Wound Surface Treatment 创面治疗Princples 原则:Protect保护, Reducing exude 减少渗液Prevent wound infection 预防伤口感染Remove necrotic tissue 清除坏死组织, Cover surface 覆盖表面（植皮） Prevent 预防 Scar contract

30、ure and deformity疤痕挛缩及畸形Plastic 整形 Better appearance 美观Wound surface treatment 创面治疗:Bind up wound 包扎伤口;Half-exposure 半暴露（？）;(Iodophor 碘伏)Exposure 暴露;(Flamazine 磺胺嘧啶银)Early stage treatment 早期治疗- Wound surface 创面 深 。: Exposure 暴露, Operation 手术 Operation 手术:Shaving eschar 焦痂剃除：深 。Cutting eschar 焦痂切除： 。

31、Skin-grafting operation 植皮手术Sources 来源 Autologous skin 自体皮, alloskin 同种异体皮, xenoskin 异种皮Free skin graft 自由皮瓣移植 Ultra thin Thickness 表层, Thickness 层（Thin 薄/thick 厚）, Full Thickness 全层Flap grafting 皮瓣移植 with vessel pedicle 血管蒂, free flap 游离皮瓣 Ultra thin ThicknessThickness Full ThicknessCommonly used methods of skin-grafting 植皮手术常用方法Reticular- autologous skin 网状-自体皮Stamp skin-grafting（？） Alloskin 同种异体皮/xeno