分析大面积严重烧伤住院患者的流行病学特征，为今后在烧伤治疗领域可能存在的问题及烧伤预防策略提供更详细的依据。

收集河北省唐山市工人医院烧伤研究所2013年8月1日至2020年7月31日的烧伤总面积≥30%总体表面积(TBSA)或烧伤严重程度为重度、特重度住院患者的病历资料。将患者分为3个年龄段：≤18岁；>18岁且<60岁；≥60岁，将居住地分为农村和城市，统计分析患者的一般人口学资料、受伤情况、临床特征、治疗情况。对数据行χ²检验，Fisher确切概率法、Kruskal-Wallis检验、Mann-Whitney U检验，对影响大面积严重烧伤患者临床预后因素行Logistic回归分析。

本次研究调查共收集了大面积严重烧伤住院患者病历资料414例，占同期烧伤住院患者总数(4 222例)的9.8%。男女比例为3.14∶1.0；3个年龄段中>18岁且<60岁患者最多(70.0%)；居住地为农村有371例(89.6%)，农村与城市的患者比例为8.6∶1.0。不同年龄段患者在性别分布上，差异有统计学意义(χ²＝31.530，P<0.01)，不同年龄段患者居住地构成比分布比较差异无统计学意义(χ²＝0.899，P＝0.626)。本研究患者受伤时间在4~9月较多，其中7月(71例，17.1%)为高峰期，烧伤多发生在夏季175例(42.3%)，各季节中烧伤患者构成比比较，差异无统计学意义(χ²＝3.749，P＝0.711)。致伤地点主要为家里215例(51.9%)，不同年龄段患者在致伤地点分布上，差异有统计学意义(χ²＝99.366, P<0.01)，患者致伤原因以火焰烧伤为主287例(69.3%)。不同年龄段患者在致伤原因分布上，差异有统计学意义(χ²＝83.569, P<0.01)。本研究患者的烧伤总面积在30%~39% TBSA的范围患者最多为127例(30.7%)，不同年龄段患者在烧伤总面积的分布上差异有统计学意义(H ＝54.914，P<0.01)，大部分患者呈特重度烧伤者有277例(54.8%)，不同年龄段患者在烧伤严重程度的分布上差异有统计学意义(χ²＝35.292, P<0.01)。本研究患者致伤部位比例从高到低依次为躯干、双下肢、双上肢、头面颈部、臀部及会阴，各年龄段患者在烧伤部位为双上肢、双下肢、头面颈、臀部及会阴构成比比较上，差异均有统计学意义(χ²＝20.328、39.067、17.133、8.349，P<0.01)，各年龄段患者在烧伤部位为躯干构成比比较上，差异无统计学意义(χ²＝3.587, P＝0.166)。本研究患者伤后入院时间<6 h入院者355例(85.7%)最多，3个年龄段患者在伤后入院时间上，差异无统计学意义(χ²＝2.253, P＝0.691)。本研究患者院前处理以在现场未行任何处理者393例(94.9%)为主，3个年龄段患者在院前处理上，差异无统计学意义(χ²＝2.931, P＝0.543)。本研究患者中绝大部分未合并吸入性损伤342例(82.6%)，各年龄段患者在合并吸入性损伤构成比比较上，差异无统计学意义(χ²＝5.892, P ＝0.053)，各种致伤原因中火焰烧伤是合并吸入性损伤，患者数最多72例(25.1%)，各种致伤原因患者在合并吸入性损伤构成比比较上，差异有统计学意义(χ²＝38.568, P<0.01)，居住地为城市的患者合并吸入性损伤为10例(23.3%)，各居住地患者在合并吸入性损伤构成比比较上，差异无统计学意义(χ²＝1.149, P＝0.284)。本研究患者有219例采取手术治疗，手术率为52.9%，其中住院期间实施4次手术的患者最多为99例(23.9%)。本研究绝大部分患者付费方式为自费381例(92.0%)，各年龄段患者付费方式比较差异无统计学意义(χ²＝5.435, P＝0.066)，自费患者中又以居住地为农村的最多，比例为92.7%，农村与城市患者付费方式比较差异无统计学意义(P>0.05)。本研究患者住院时间均以>21 d为主，各年龄段烧伤住院患者在住院时间构成比比较上，差异无统计学意义(χ²＝11.764, P＝0.067)。本研究患者临床预后以痊愈、好转为主有358例(86.5%)，痊愈130例(31.4%)、好转228例(55.1%)、恶化26例(6.3%)、死亡30例(7.2%)，不同年龄烧伤患者在临床预后分布上差异有统计学意义(H＝13.607, P＝0.001)。本研究患者病死率为7.2%，年龄和Ⅲ度烧伤面积是大面积严重烧伤患者临床未愈的独立危险因素(OR＝1.046、1.098，95%CI＝1.021~1.071、1.066~1.131，P<0.01)。

我国大面积严重烧伤主要见于中青年及老年，农村男性居多、致伤原因多为火焰烧伤，高发与春夏季常见于工作场所烧伤，病情往往较严重，致伤部位以躯干、双下肢、双上肢较多，自费为主要付费方式。不同年龄患者在性别、致伤原因、致伤场所、烧伤总面积、烧伤严重程度、烧伤部位及临床预后存在明显差异。

To analyze the epidemiological characteristics of hospitalized patients with severe burns over a large area to provide a more detailed basis for possible future problems in the field of burn treatment and burn prevention strategies.

Medical records of patients hospitalized with total burn area≥30% total body surface area (TBSA) or burn severity of severe or extra-severe were collected from August 1, 2013, to July 31, 2020, at Department of the Burn Institute, Tangshan Workers′ Hospital in Hebei province. Patients were divided into 3 age groups: ≤18 years, >18 and <60 years, ≥60 years, and the place of residence was divided into rural and urban areas, and the general demographic data, injuries, clinical characteristics, and treatment of patients were statistically analyzed. The data were analyzed by χ² test, Fisher′s exact probability method, Kruskal-Wallis test, Mann-Whitney U test, and logistic regression analysis of factors affecting the clinical prognosis of patients with large and severe burns.

A total of 414 cases of medical records of patients hospitalized with severe burns over a large area were collected in this study survey, accounting for 9.8% of the total number of patients hospitalized with burns during the same period (4 222 cases). The ratio of male to female was 3.14∶1.00; patients aged>18 and <60 years accounted for 70.0% of the total number of patients in the three age groups; there were 371 cases (89.6%) with rural residence, and the ratio of rural to urban patients was 8.6∶1.0. The difference in the distribution of patients in different age groups by gender was statistically significant (χ²=31.530, P<0.01), and the distribution of patients in different age groups by residence composition ratio was not statistically significant, the difference was not statistically significant (χ²=0.899, P=0.626). There were more patients with burns from April to September, with July (71 cases, 17.1%) being the peak month. One hundred and seventy-five cases (42.3%) of burns happened in summer, and the difference in the composition ratio of patients with burns in each season was not statistically significant (χ²=3.749, P=0.711). The location of injury was mainly at home in 215 cases (51.9%), and the difference in the distribution of injury locations was statistically significant in different age groups (χ²=99.366, P< 0.01), and the cause of injury was mainly flame burns in 287 cases (69.3%). The difference in the distribution of causes of injury among different age groups was statistically significant (χ²=83.569, P< 0.01). The maximum number of patients in this group with total burn area in the range of 30% to 39% TBSA was 127 (30.7%), and there was a significant difference in the distribution of total burn area between different age groups (H=54.914, P< 0.01), and most of the patients had extra-severe burns in 277 cases (54.8%). There was a significant difference in the distribution of burn severity among different age groups (χ²=35.292, P< 0.01). In this group of patients, the proportion of injury sites in descending order was the trunk, lower extremities, upper extremities, head, face and neck, buttocks, and perineum, and there were statistically significant differences in the ratio of burn sites for upper extremities, lower extremities, head, face and neck, buttocks and perineum in each age group (χ²=20.328, 39.067, 17.133, 8.349; P< 0.01), and there was a statistically significant difference in the distribution of burn sites for the trunk, lower extremities, head, face and neck, buttocks and perineum in each age group. The difference was not statistically significant in the comparison of the composition ratio of patients with burns at the site of the trunk (χ²=3.587, P=0.166). The time of post-injury admission in this group was 355 (85.7%), and the difference between the three groups was not statistically significant (χ²=2.253, P=0.691). The pre-hospital management of patients in this group was mainly 393 cases (94.9%) who did not have any treatment at the scene, and the difference in pre-hospital management was not statistically significant among the three groups (χ²=2.931, P=0.543). The majority of the patients in this group did not have combined inhalation injury 342 cases (82.6%), and the difference in the composition of combined inhalation injury among patients of all ages was not statistically significant (χ²=5.892, P=0.053), and the number of patients with combined inhalation injury was 72 cases (25.1%) among all causes of injury. The difference was statistically significant (χ²=38.568, P<0.01), and the number of patients with combined inhalation injury was 10 cases (23.3%) for patients with the urban residence). In this study, 219 patients were treated surgically, with a surgical rate of 52.9%, of which 99 cases (23.9%) underwent four surgeries during hospitalization. The majority of patients in this group were self-pay 381 cases (92.0%), and the difference between the payment methods of patients of all ages was not significant (χ²=5.435, P=0.066), and the most self-pay patients were those who lived in rural areas, with a proportion of 92.7%. The number of days of hospitalization in this group of patients was mainly greater than 21 d. The difference in the composition of the number of days of hospitalization among burn patients of all ages was not statistically significant (χ²=11.764, P=0.067). The clinical prognosis of our patients was mainly healed and improved in 358 cases (86.5%), healed in 130 cases (31.4%), improved in 228 cases (55.1%), deteriorated in 26 cases (6.3%), and died in 30 cases (7.2%), and there was a significant difference in the distribution of clinical prognosis of burn patients in different age groups (H=13.607, P=0.001). The mortality rate in this group was 7.2%, and age and third-degree burn area was independent risk factors for clinical failure in patients with large severe burns (odds ratio=1.046, 1.098, 95%confidence interval=1.021-1.071, 1.066-1.131; P<0.01).

Large severe burns in China are mainly seen in young and middle-aged people and the elderly, with a predominance of rural males, and the cause of injury is mostly flame burns, which are common in workplace burns in spring and summer, and are often more severe, with more injury sites on the trunk, both lower extremities, and both upper extremities, and self-payment is the main payment method. There were significant differences in gender, cause of injury, place of the injury, the total burn area, burn severity, burn site, and clinical prognosis among different age groups of patients.