寶用利永方第26卷第23期201112月J4 Clin Pedi,w26N23,D21·論著DOI:10.3969/j.isn.1003-515X.2011.23.013兒童燒傷的社會(huì)因素分析吳杭慶!,常菲2,王良喜,孫勇(1.解放軍第九七醫(yī)院燒傷整形科,江蘇徐州221004;2.第二軍醫(yī)大學(xué)附屬長(zhǎng)海醫(yī)院燒傷中心,上海20043)摘要:目的探討兒童燒傷的特點(diǎn)并分析其相關(guān)的社會(huì)因素。方法回顧性研究長(zhǎng)海醫(yī)院燒傷中心2007年1月-2008年12月住院及門(mén)急診治療的226例兒童燒傷的相關(guān)因素包括人群分布特點(diǎn)、致傷時(shí)間及日期致傷地點(diǎn)、致傷原因燒傷總體表面積家長(zhǎng)學(xué)歷、預(yù)防措施、急救措施住院天數(shù)、家庭經(jīng)濟(jì)狀況等。采用sPs13.0軟件進(jìn)行數(shù)據(jù)分析。結(jié)果3歲以下兒章所占比例最大,大多數(shù)燒傷發(fā)生在家中最常見(jiàn)的燒傷是熱液燙傷。外來(lái)兒童與當(dāng)?shù)貎和急壤喈?dāng)。對(duì)于已上學(xué)的兒童,節(jié)假日或周末燒傷發(fā)生率顯著高于未上學(xué)者。多數(shù)家庭對(duì)兒童的看護(hù)措施未能有效地預(yù)防燒傷。在燒傷預(yù)防意識(shí)及急救措施方面,學(xué)歷較高的家庭有較強(qiáng)的預(yù)防意識(shí),且對(duì)燒傷的急救措施顯著優(yōu)于學(xué)歷較低者。家庭經(jīng)濟(jì)收入高低顯著影響患兒的治療,家庭經(jīng)濟(jì)收入與住院天數(shù)有一定相關(guān)性。結(jié)論特殊時(shí)期(假期及周未)、看護(hù)措施家長(zhǎng)學(xué)歷及家庭經(jīng)濟(jì)狀況是影響兒童燒傷的重要社會(huì)因素,應(yīng)基于這些因素形成綜合的兒童燒傷預(yù)防體系。實(shí)用兒科臨床雜志,2011,》6(23:1799-1800關(guān)鍵詞:燒傷;燒傷預(yù)防;教育背景;經(jīng)濟(jì)狀況;兒童中圖分類(lèi)號(hào):R726.1文獻(xiàn)標(biāo)識(shí)碼:A文章編號(hào):1003-515X(2011)23-1799-02Analysis of Social Factors Affecting Pediatric BurnsWU Hang-ging', CHANG Fei, WANG Liang-xi', SUN Yong'(1. Department of Burn and Plastic Surgery, the No 97 Hospital of the People' s Liberation Army, Xuzhou 221004, Jiangsu Province, China; 2Burn Center, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai 200433, China)Abstract: Objective To study the characteristics of pediatric burns and analyze the related social factors. Methods A retrospectivestudy was performed from Jan. 2007 to Dec. 2008 at the Burn Center, Changhai Hospital. Medical records of 226 children including hospita-ized ones as well as outpatients with burns were reviewed. Data regarding demographic distribution, time and date of bum, place of burn, etio.logy of burn total body surface area of burn, educational background of the families, preventive measures, first-aid measures, length of hospitalstay, and economic status of the families were analyzed. Statistical analysis was undertaken by SPSS 13. 0 statistical software. Results Themajonity of burns occurred in children below 3 years old. Most bums happened at home and the most common one was scald. The number ofmigrant burned children was equal to that of resident burned children. The incidence of bums during holidays or weekends was higher for thosewho went to school. Most of the direct supervision failed to prevent children from bums. The educational background of the families exerted im-portant impacts on bum prevention as well as first aids. The family economic status played an important role on the therapy of pediatric burnsand length of hospital stay was correlated with family economic status. Conclusions Special time such as holidays and weekends, familypervision, educational background of the families and the family economic status are important social factors affecting pediatric burns. A comprehensive pediatric burn prevention system shall focus on the risk factors leading to a high incidence of burns.J Appl Clin Pediatr, 2011, 26 (23) 1799-1800Key words: bums; bum prevention; educational background; economic status; child兒童燒傷是最嚴(yán)重兒童外傷之一。對(duì)其發(fā)育以及生燒傷程度、急救措施、住院天數(shù)、父母學(xué)歷及家庭經(jīng)濟(jì)狀活質(zhì)量均將產(chǎn)生嚴(yán)重的影響13。關(guān)于兒童燒傷的很多況等。將學(xué)歷分為小學(xué)(≤6a)初中(≤9a)高中(≤方面都有了較系統(tǒng)研究,但目前關(guān)于兒童燒傷的報(bào)道大12a)以及大學(xué)(>12a)。根據(jù)學(xué)歷將不同的家庭進(jìn)行分都是對(duì)住院患兒進(jìn)行研究4),門(mén)診和急診處理的患兒并組,研究家長(zhǎng)學(xué)歷對(duì)兒童燒傷預(yù)防及急救的影響。研究未包括在研究資料中。而從流行病學(xué)角度來(lái)講,住院患家庭經(jīng)濟(jì)狀況對(duì)平均住院日的影響,除11例三度燒傷患者只能在一定程度上代表該病種的一些特性,很可能導(dǎo)者及45例燒傷面積過(guò)大及過(guò)小的患者外,余108例住院致片面評(píng)估兒童燒傷特點(diǎn)。本研究對(duì)在本院住院及門(mén)、患兒深二度燒傷面積為4%~10%總體表面積(TBSA),急診燒傷患兒226例進(jìn)行探討。現(xiàn)報(bào)告如下。以使病情相對(duì)接近。資料與方法1.2統(tǒng)計(jì)學(xué)處理采用SPSs13.0軟件進(jìn)行分析,對(duì)人1.1一般資料回顧性研究2007年1月-2008年12群分布燒傷與節(jié)假日的關(guān)系燒傷時(shí)看護(hù)情況家長(zhǎng)學(xué)月長(zhǎng)海醫(yī)院燒傷中心救治的268例燒傷兒童(3個(gè)月~14歷對(duì)兒童燒傷急救及預(yù)防的影響家庭經(jīng)濟(jì)狀況對(duì)住院歲)的臨床資料包括住院及門(mén)急診就診的患兒除外42治療的影響等方面的統(tǒng)計(jì)數(shù)據(jù)采用x2檢驗(yàn)進(jìn)行分析對(duì)例不配合調(diào)查研究的患者,226例納入研究。其中住院家庭經(jīng)濟(jì)狀況對(duì)住院天數(shù)的影響采用相關(guān)性分析并采用164例,門(mén)診治療48例,急診救治14例。研究資料包括檢驗(yàn)。P<00V山中國(guó)煤化工患兒性別、年齡、地域區(qū)別、致傷原因及地點(diǎn)致傷時(shí)間、2結(jié)果CNMHG作者簡(jiǎn)介:吳杭慶,男,住院醫(yī)師,碩土學(xué)位,研究方向?yàn)闊齻?電子信箱2.1人群分布226例中,男女比例為1.8:1,住院患hhhh@yahoo.com.cn兒男女比例為1.7:1。3歲以下占比例最大(63.7%),·1800·強(qiáng)用科臨承右第26卷第x3期2011年12月 J ApP! CHin Pediat.t26Mx,D201而在年齡相對(duì)較小的群組,男童發(fā)生燒傷的危險(xiǎn)性相對(duì)低收入者(x2=63.00,P<0.005;t=14.806,P<0.001)較高。在所有燒傷兒童中,外來(lái)兒童與當(dāng)?shù)貎和急葘?duì)于深二度燒傷患兒,家庭經(jīng)濟(jì)狀況與平均住院日有例相當(dāng)(x2=1.65,P>0.05),見(jiàn)表12。定相關(guān)性(r=0.5355,P<0.005),燒傷面積與住院時(shí)間表1燒傷患兒性別、年齡分布m)無(wú)相關(guān)性(r=0.1357,P>0.05),見(jiàn)表6性別3個(gè)月-3歲4-6歲7~14歲表6家庭經(jīng)濟(jì)狀況對(duì)燒傷患兒住院與否及住院天數(shù)的影響男3018家庭月收入/元住院不住院總數(shù)住院天>600016.73±2.57144(63.7%0.4%(15.9%≤600030467611.40±2.53表2燒傷患兒人群地域分布及住院治療情況性別冬(當(dāng)?shù)厝丝谕鈦?lái)人口是(住院)否223討論男5840燒傷是兒童最常見(jiàn)且最嚴(yán)重的外傷之一。對(duì)于小兒燒傷,3歲以下兒童占比例最大。大部分燒傷是發(fā)生22燒傷與假期及周末的相關(guān)性已經(jīng)上學(xué)(包括幼兒在家中或家庭附近311,其中熱液燙傷是最主要的致園)的兒童假期或周末燒傷發(fā)生率(5778例)明顯高于傷原因6,。燒傷與生活方式和環(huán)境有關(guān)。上海是我非上學(xué)者(49148例)(x2=32.7,P<0.05)。國(guó)流動(dòng)人口最多的城市之一,2007年上海外來(lái)人口66023燒傷時(shí)的看護(hù)情況對(duì)6歲以下兒童家長(zhǎng)對(duì)其看萬(wàn)人,占全市總?cè)丝诘?/3還多。近年來(lái),由于城市建設(shè)護(hù)明顯多于7-14歲兒童(x2=17.01,P<0.005),但前力度加大,入城外來(lái)人口仍在逐漸增加。外來(lái)人口家庭者在燒傷兒童中所占比例卻遠(yuǎn)高于后者,見(jiàn)表3。相對(duì)貧窮,居住環(huán)境擁擠,外來(lái)兒童燒傷發(fā)生率較當(dāng)?shù)乇?不同年齡幾童燒傷時(shí)看護(hù)情況比較兒童高。本研究發(fā)現(xiàn),外來(lái)兒童與當(dāng)?shù)貎和跓齻麅河腥丝醋o(hù)無(wú)人看護(hù)3個(gè)月~6歲190(84.07%)童中所占的比例相當(dāng),無(wú)統(tǒng)計(jì)學(xué)差異。本研究包含住院7-14歲2036(1593%)患兒以及非住院患兒,其流行病學(xué)研究結(jié)果更接近實(shí)際情合計(jì)況。近年來(lái),雖然外來(lái)人口在增加,但是由于計(jì)劃生育的繼24家長(zhǎng)學(xué)歷與燒傷預(yù)防意識(shí)學(xué)歷在大學(xué)及以上的續(xù)實(shí)施以及城市生活的壓力加大,外來(lái)人口每個(gè)家庭生育家長(zhǎng)與學(xué)歷大學(xué)以下的家長(zhǎng)比較,前者有較強(qiáng)的燒傷預(yù)子女?dāng)?shù)減少加之燒傷預(yù)防意識(shí)逐漸增強(qiáng),外來(lái)兒童燒傷發(fā)防意識(shí)(x2=3278,P<0.005);高中及以上學(xué)歷和高中生率降低,從而導(dǎo)致外來(lái)兒童燒傷所占比例下降。以下學(xué)歷組中,前者有燒傷預(yù)防意識(shí)的家長(zhǎng)比例較高因?yàn)榇蟛糠譄齻l(fā)生在家中,所以對(duì)兒童看護(hù)不夠(x2=6.04,P<0.05)。見(jiàn)表4?；虿徽_是發(fā)生燒傷的最主要原因。對(duì)于6歲以下兒饔4家長(zhǎng)學(xué)歷不同的家庭燒傷預(yù)防意識(shí)比較童,家長(zhǎng)對(duì)其看護(hù)明顯多于7~14年齡階段者,因?yàn)楹笳呒议L(zhǎng)學(xué)歷有預(yù)防意識(shí)。無(wú)須防意識(shí)合計(jì)的主的主要活動(dòng)時(shí)間是在學(xué)校,但前者在燒傷兒童中所占的大學(xué)及以上大學(xué)以下高中及以上6406比例卻遠(yuǎn)高于后者。這說(shuō)明對(duì)兒童的看護(hù)并沒(méi)有起到很好的作用,而家長(zhǎng)不能在高發(fā)時(shí)段或地點(diǎn)加強(qiáng)看護(hù),也是高中以下導(dǎo)致前者燒傷發(fā)生率較高的原因。年長(zhǎng)兒童在自我保護(hù)合計(jì)0002.5家長(zhǎng)學(xué)歷與燒傷急救措施本研究?jī)H74例患兒使意識(shí)上也強(qiáng)于低齡兒童。而對(duì)于已上學(xué)(包括幼兒園)的兒童來(lái)說(shuō),假期或周末燒傷發(fā)生率明顯高于非上學(xué)者,因用冷水沖洗創(chuàng)面但是沖洗時(shí)間均較短,大多少于2m,為假期或周末期間,兒童在家時(shí)間相對(duì)較多,而家中是燒沖洗10min以上僅28例。以沖洗10min以上為相對(duì)正傷最常發(fā)生的場(chǎng)所。除了一天中有發(fā)病高峰時(shí)間外,燒確的處理方法,本研究發(fā)現(xiàn),學(xué)歷在大學(xué)及以上的家長(zhǎng)與傷也有一定的季節(jié)性6。此外,特殊節(jié)假日特殊時(shí)間學(xué)歷大學(xué)以下的家長(zhǎng)比較,前者作出正確急救的比例較和事件與兒童燒傷發(fā)生也有直接關(guān)系6H。高(x2=16.60,P<0.005);但高中及以上學(xué)歷與高中以本結(jié)果表明,學(xué)歷相對(duì)較高的家庭具有較強(qiáng)的燒傷下學(xué)歷兩組中,作出正確急救者所占比例比較無(wú)統(tǒng)計(jì)學(xué)預(yù)防意識(shí)。本研究不少家長(zhǎng)雖然有預(yù)防意識(shí),但在具體差異(x2=280,P>0.05)。見(jiàn)表5措施上做得不夠好,如明知道熱水瓶對(duì)兒童是個(gè)危險(xiǎn)因表5家長(zhǎng)學(xué)歷不同的家庭急教措施正確與否比較家長(zhǎng)學(xué)歷急救措施止確急救措施錯(cuò)誤素,但是在水瓶放置上還是不注意,從而導(dǎo)致兒童燒傷發(fā)大學(xué)及以上58生等。大學(xué)以下對(duì)燒傷的正確處理措施為在受傷3h內(nèi)用冷水沖洗高中及以上l01高中以下創(chuàng)面20-3V凵中國(guó)煤化工其他東西馬上去醫(yī)院治療CNMH,只有少數(shù)家長(zhǎng)使2.6家庭經(jīng)濟(jì)狀況對(duì)住院治療的影響家庭經(jīng)濟(jì)收入用冷水,大部分家長(zhǎng)措施往往是錯(cuò)誤的。本研究在每月6000元以上者住院人數(shù)及平均住院日明顯高于僅74例使用冷水沖洗創(chuàng)面(下轉(zhuǎn)第1844頁(yè))寶用兒利臨示方第26卷第2期2011年12月J4m! 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American Academy of Pediatries, 2009: 423-430況比較及其改進(jìn)策略[]中國(guó)兒童保健雜志,2008,16(3):290[8] Lowe NM, Fekete K, Decsi T Methods of assessment of zinc status in hu-nans: A systematic review[J]. Am J Clin Nutr, 2009, 89(6): $2040[ 14] Jeejeebhoy K. Zinc: An essential trace element for parenteral nutritions205lGastroenterology, 2009, 137(5 suppl ) 7-12[9] Hotz C, Peerson JM, Brown KH. Suggested lower cutoffs of serum zinc [15] Hambidge KM. Zine and pneumonia[ J ]. Am J Clin Nutr, 2006, 83concentrations for assessing zinc status: Reanalysis of the second Natio-(5):991-992al Health and Nutrition Examination Survey data( 1976-1980)[J]收稿日期:2011-10-20)utr,2003,78(4):756-764(本文編輯:王家勤)[ 10] Hotz C, Lowe NM, Araya M, et al. Assessment of the trace element sta-(上接第1800頁(yè))但是沖洗時(shí)間均較短,多在2min以下,[3] Stubbs TK, James LE, Daugherty MB, et al. Psychosocial impact of child-沖洗10mn以上者僅28例。以沖洗10min以上為相對(duì)od face bums: A multicenter, prospective, longitudinal study of 390hildren and adolescents[ J]. Burns, 2011, 37(3): 387-394.正確的處理方法,家長(zhǎng)學(xué)歷在大學(xué)及以上的家庭在正確4] Wang H,XioJ, Zhang J,aal. Comparable results of epidemiology of急救方面優(yōu)于學(xué)歷較低者。但絕大部分家庭對(duì)燒傷的急hildren with burns among different decades in a burn unit in JinzhouChina[J].Bums,2011,37(3):513-520救措施都是錯(cuò)誤的。迅速的急救措施可阻止淺度燒傷發(fā)[5] Albertyn R, Bickler SW, Rode h., Paediatric burn injuries in Sub Saha展為需要手術(shù)植皮的深度燒傷因此對(duì)兒童燒傷進(jìn)行正(6 Goldman S, Aharonson Daniel L,Pegk, al. Childhood bums in Israel: A確急救很重要。因此,應(yīng)加強(qiáng)燒傷常識(shí)的教育力度97-year epidemiological review[J]. Burns, 2006, 32(4): 467-472與其他兒童外傷相比較,燒傷兒童需住院治療比例[7] Fadeyibitaha LA, Ibrahim NA, et al. Characteristics of paediatric bums seen at a tertiary centre in a low income country A five year更高,而且很多患兒住院時(shí)間長(zhǎng)、且需要更多治療。有研(2004-2008) study[J].Bums,2011,37(3):528-534究指出燒傷面積與住院時(shí)間有一定相關(guān)性,本研究108【8]LKY,husH, Tang HT,ea, The direct hospitalisation costs of pae-diatric scalds: 2-year results of a prospective case series[ J].Burns例深二度燒傷患兒中,燒傷面積與住院時(shí)間沒(méi)有相關(guān)性,2009,35(5):738-745排除了燒傷面積過(guò)大或過(guò)小對(duì)住院時(shí)間的影響,從而使9)PabA, Louw QA, Grimmer-Somers K. Bum prevention programsfor children in developing countries require urgent attention: A targeted燒傷深度成為影響愈合時(shí)間主要因素。對(duì)于燒傷深度相l(xiāng)iterature review[J]. Burns, 2010, 36(2 ): 164-175同病情相近患兒,家庭經(jīng)濟(jì)狀況對(duì)住院時(shí)間有一定程度10] Torabian S.shMs. Epidemiology of paediatric bum injuries inHamadan, Iran[ J]. Burns, 2009, 35(8): 1147-1151影響。研究發(fā)現(xiàn),家庭經(jīng)濟(jì)收入較高組更傾向于住院治[ Yarow J, Movemen N, Gulhane s. Early management of burns in chil-dren[ j]. Paediatr Child Health, 2009, 19(11): 509-516[12]程金江小兒燒傷1135例的原因[J].實(shí)用兒科臨床雜志,2011,對(duì)燒傷進(jìn)行性的監(jiān)測(cè)可以確定高危人群、流行病學(xué)6(6):l298-1299特點(diǎn)及發(fā)展趨勢(shì),并可以評(píng)估干預(yù)措施的有效性。兒[13] Wang X, Zhang Y, Zhang Q,a. Characteristics o1494pditburm patients in Shanghai[J]. Burns, 2006, 32(5): 613-618童燒傷多是偶然性的,因此也是可以預(yù)防的。燒傷[14 Woodbridge TR, Weisfeld- Adams JD, Wilkins EC, et al. Epidemiology預(yù)防知識(shí)的宣傳及相關(guān)教育對(duì)降低兒童燒傷發(fā)生率起到inyunes occumngholidays[門(mén)]. burns,2010,36(7):1096-1100.了顯著效果:。除了加強(qiáng)家庭預(yù)防措施外,還要加強(qiáng)5 Rea S, Kuthubutheen, Fowler E.,a. Bum first aid in Westen ar社會(huì)和政府干預(yù)°。因此提高家庭的社會(huì)經(jīng)濟(jì)狀況、提t(yī)ralia-Do healtheare workers have the knowledge[ J]? Burns, 200531(8):1029-1034.高父母的受教育水平、改善居住條件、正確存放易致傷物[16] Araoz b.Fit- aid home treatment of bums among children and some質(zhì)給予兒童足夠看護(hù),這些都是預(yù)防燒傷的重要措施。implications at milas, Turkey[J]. J Emergency Nursing, 2010, 36(2):lll-114.對(duì)燒傷的預(yù)防應(yīng)當(dāng)以高危人群為主要對(duì)象,并且要側(cè)重[17] Light TD, tenser BA, Heinle JA,al. Jaggery: An avoidable cause of于不同人群特性。綜合預(yù)防策略體系有待個(gè)人家庭severe, deadly pediatric bums[ J]. Burns, 2009, 35(3):430政府乃至整個(gè)社會(huì)共同努力去實(shí)現(xiàn)9[18 ]Jetten P, Chamania S, van Tulder M Evaluation of a community-basedprevention program for domestic bums of young children in India[ J]Burs,2011,37(1):139-144.參考文獻(xiàn)[1] Park Jo, Shin SD, Kim J, et al. Association between socioeconomic status[19] Rajan V, Abeyasundara SL, Harvey JG, et al. Exhaust bums in childrenand burn injury severity[ J].Burns, 2009, 35(4): 482-490.[刀.Bu20u372)273-276[2]Weedon M. Potterton J. Socio-economic and clinical factors predictive中國(guó)煤化工離日期:2011-09-05)of paediatric quality of life post burn[ J]. Burns, 2011, 37(4): 572CNMHG本文編輯:張耀東