探讨区域性静脉灌注葡萄糖酸钙治疗手指氢氟酸烧伤的临床疗效和安全性。

2018年5月至2022年6月，浙江衢化医院烧伤与创面修复科收治符合纳入与排除标准的手指氢氟酸烧伤患者40例。收集患者一般临床资料，包括受伤手指分布、创面面积及深度、致伤氢氟酸质量分数、持续接触氢氟酸时间以及院前时间。患者均采用区域性静脉灌注葡萄糖酸钙治疗，灌注液为100 g/L葡萄糖酸钙溶液15 ml、生理盐水35 ml及肝素钠0.1 ml。创面彻底清创，拔除受累指甲，每天1次常规换药。记录患者入院时血清总钙、游离钙、血清钾、血清镁、血氟、尿氟和心电图情况。采用视觉模拟评分法(VAS)评估患者灌注前、灌注后即刻、灌注后4 h以及灌注后24 h疼痛程度。统计患者灌注后4、12及24 h血清总钙、游离钙、尿氟及灌注后24 h血氟水平。统计灌注过程中及灌注结束后24 h内发生的不良反应，以及烧伤创面愈合情况。

(1)本组患者中男32例，女8例，年龄主要集中在30～50岁(24例)，所在企业以非氟化工企业为主，单手烧伤35例，双手烧伤5例，共累及83指，烧伤总面积均<1%总体表面积(TBSA)，烧伤深度为Ⅱ～Ⅳ度，其中以Ⅱ度为主(30例)。仅有18例患者致伤氢氟酸质量分数已知，持续接触氢氟酸时间为30.0(14.3，48.8)min，院前时间为9.0(3.3，19.0)h。(2)患者均经单次区域性静脉灌注葡萄糖酸钙治疗后，疼痛明显缓解。灌注前、灌注后即刻、灌注后4 h、灌注后24 h之间比较，疼痛评分呈进行性下降(P<0.01)。(3)患者入院时，以游离钙为参考有11例低钙血症，另外有5例低钾血症。与入院时比较，灌注后4 h血清总钙水平明显升高(P<0.05)；与灌注后4 h比较，灌注后12、24 h血清总钙水平明显下降(P<0.01)。与入院时比较，灌注后4 h游离钙水平明显升高(P<0.01)；灌注后4、12、24 h之间比较，游离钙水平逐渐下降(P<0.01)。(4)患者入院时，有15例血氟高于正常值，尿氟均高于正常值。与入院时比较，灌注后24 h血氟水平明显下降(P<0.01)；入院时及灌注后4、12、24 h之间比较，尿氟水平逐渐下降(P<0.01)。(5)所有患者在灌注过程中及灌注结束后24 h内，未发生不良反应。创面愈合时间为4.0～30.0(11.1±5.9)d，35例经换药治疗创面愈合，5例通过手术治疗后愈合。

即使手指氢氟酸烧伤总面积<1%TBSA，伤后患者血氟、尿氟水平仍可升高数十倍，并伴有电解质紊乱。采用区域性静脉灌注葡萄糖酸钙治疗手指氢氟酸烧伤，临床疗效显著，操作简单且安全性高，可以明显减轻疼痛，有效阻断氟离子进行性损害。

To investigate the clinical effectiveness and safety of regional intravenous perfusion of calcium gluconate for treatment of hydrofluoric acid burns in fingers.

A total of 40 patients with finger hydrofluoric acid burns who met the inclusion and exclusion criteria were admitted to the Department of Burns and Wound Repair, Zhejiang Quhua Hospital from May 2018 to June 2022. Collected the general clinical data of the patients, including the distribution of injured fingers, the area and depth of wounds, the mass fraction of injured hydrofluoric acid, the time of continuous exposure to hydrofluoric acid, and the pre-hospital time. All patients were treated with regional intravenous infusion of calcium gluconate, with an infusion solution of 15 ml of 100 g/L calcium gluconate solution, 35 ml of physiological saline, and 0.1 ml of heparin sodium. The wounds were thoroughly debrided, the affected nails were removed, and routine dressing changes were performed once a day. Recorded the serum total calcium, free calcium, serum potassium, serum magnesium, blood fluoride, urine fluoride, and electrocardiogram of the patients at admission. Visual analog scale (VAS) was used to evaluate the degree of pain before perfusion, immediately after perfusion, 4 and 24 h after perfusion. Recorded the serum total calcium, free calcium, urinary fluoride, and 24-hour blood fluoride levels of patients after perfusion. Counted the adverse reactions during the perfusion and within 24 h after perfusion, as well as the healing of burn wounds.

(1) The patients included 32 males and 8 females, with majority aged 30 to 50 years (24 patients). The company were mainly non-fluorine chemical enterprises. There were 35 patients with single hand burns and 5 patients with double hand burns, and 83 fingers were involved. The total burn area was below 1% of the total body surface area (TBSA). The depth of burn was Ⅱ to Ⅳ degrees, the majority depth was Ⅱ degrees (30 patients). The hydrofluoric acid mass fraction was known in only 18 patients. The time of continuous exposure to hydrofluoric acid was 30.0(14.3, 48.8)min, and the pre-hospital time was 9.0(3.3, 19.0)h. (2) After single regional intravenous perfusion of calcium gluconate, the pain of all patients was significantly relieved. The pain score progressively decreased compared among before perfusion, immediately after perfusion, at 4 h and 24 h after perfusion (P<0.01). (3) When the patients were admitted to the hospital, according to the free calcium, there were 11 patients with hypocalcemia. In addition, there were 5 patients with hypokalemia. Compared with that at admission, the serum total calcium level was increased significantly at 4 h after perfusion (P<0.05); compared with 4 h after perfusion, the serum total calcium level was decreased significantly at 12 and 24 h after perfusion (P<0.01). Compared with that at admission, the free calcium was increased significantly at 4 h after perfusion (P<0.01); the free calcium level gradually decreased at 4, 12 and 24 h after perfusion (P<0.01). (4) When the patients were admitted to the hospital, there were 15 patients whose blood fluoride levels were higher than the normal value, the urine fluoride levels were all higher than the normal value. Compared with that at admission, the blood fluoride level was decreased significantly at 24 h after perfusion (P<0.01).The urine fluoride level was gradually decreased at admission and 4, 12 and 24 h after perfusion (P<0.01). (5) All patients had no adverse reactions during the perfusion process and within 24 h after perfusion. The wound healing time was 4.0-30.0 (11.1±5.9)d. Thirty-five patients healed after dressing change, and 5 patients healed after surgical treatment.

Even if the total area of hydrofluoric acid burn in fingers is below 1% TBSA, the level of blood fluoride and urine fluoride can still increase ten times after injury, with electrolyte disorder. Regional intravenous perfusion of calcium gluconate for treatment of hydrofluoric acid burns in fingers has significant clinical effectiveness, with simple operation and high safety. It can not only significantly reduce pain, but also effectively block the progressive damage of fluoride ions.