大面積燒傷治療

The Treatment of Major Burn Injuries

10.6224/JN.63.1.12

林郁勳(Yu-Hsun Lin)；林秀華(Hsiu-Hua Lin)；史麗萍(Li-Ping Shi)；楊永健(Eng-Kean Yeong)

大面積燒傷 ； 治療與復健 ； major burn ； treatment and rehabilitation

護理雜誌

63卷1期（2016 / 02 / 01）

12 - 16

繁體中文

大面積燒傷是全身性的疾病，除了充分了解傷口癒合機轉外，正確燒傷深度判斷和面積評估是大面積燒傷治療重要的基本步驟。由於治療方法的快速進步，包括適當體液復甦術、早期傷口切除、早期植皮、有效的熱量補充和積極的敗血症治療等，已大大提升了大面積燒傷的存活率。然而，對大面積燒傷的存活者而言，疤痕肥厚攣縮僵硬導致關節活動受限制是後續臨床的挑戰性問題。總結，大面積燒傷治療與復健過程漫長且多面向，需要一個完整的治療計畫，及一個包括醫師、護理人員、社工、復健師和心理師的健全團隊，透過彼此間充分的溝通與相互的支持，完成協助病人重返社會為最終治療目的。

Major burn injuries constitute a systemic disease. In addition to completely understanding the mechanisms of wound healing, precise burn depth and area assessment is critical to the successful management of burn injuries. The recent advancements in post-burn fluid resuscitation, tangential burn excision and grafting, effective enteral tube feeding, and aggressive sepsis treatment have helped greatly increase the survival rates for major burn injuries. However, the restricted joint motion that results from hypertrophic scar contracture remains the main challenge facing burn survivors. In conclusion, as the course of the treatment and rehabilitation is prolonged and multifaceted, a complete treatment plan is always necessary in addition to teamwork among physicians, nurses, social workers, physical therapists, and psychologists. Finally, social return is the final goal of treatment and may be achieved only through mutual support and understanding among the members of the burn treatment and rehabilitation team.

1. Arnoldo, B. D.,Purdue, G. F.(2009).The diagnosis and management of electrical injuries.Hand Clinics,25(4),469-479.
2. Artz, C. P.(1970).Historical aspects of burn management.Surgical clinics of North America,50(6),1193-1200.
3. Giretzlehner, M.,Dirnberger, J.,Owen, R.,Haller, H. L.,Lumenta, D. B.,Kamolz, L. P.(2013).The determination of total burn surface area: How much difference?.Burns,39(6),1107-1113.
4. Keaney, T. C.,Tanzi, E.,Alster, T.(2016).Comparison of 532 nm potassium titanyl phosphate laser and 595 nm pulsed dye laser in the treatment of erythematous surgical scars: A randomized, controlled, open-label study.Dermatologic Surgery,42(1),70-76.
5. Klotz, T.,Kurmis, R.,Munn, Z.,Heath, K.,Greenwood, J. E.(2015).The effectiveness of moisturizers in the management of burn scars following burn injury: A systematic review.JBI Database of Systematic Reviews and Implementation Reports,13(10),291-315.
6. Kopp, J.,Wang, G. Y.,Horch, R. E.,Pallua, N.,Ge, S. D.(2003).Ancient traditional Chinese medicine in burn treatment: A historical review.Burns,29(5),473-478.
7. Ladak, A.,Tredget, E. E.(2009).Pathophysiology and management of the burn scar.Clinics in Plastic Surgery,36(4),661-674.
8. Mendonça Machado, N.,Gragnani, A.,Masako Ferreira, L.(2011).Burns, metabolism and nutritional requirements.Nutrición Hospitalaria,26(4),692-700.
9. Monstrey, S.,Hoeksema, H.,Verbelen, J.,Pirayesh, A.,Blondeel, P.(2008).Assessment of burn depth and burn wound healing potential.Burns,34(6),761-769.
10. Orgill, D. P.(Ed.),Blanco, C.(Ed.)(2009).Biomaterials for treating skin loss.Cambridge, UK:Woodhead.
11. Park, T. H.,Rah, D. K.(2015).Successful eradication of helical rim keloids with surgical excision followed by pressure therapy using a combination of magnets and silicone gel sheeting.International Wound Journal
12. Peeters, Y.,Vandervelden, S.,Wise, R.,Malbrain, M. L.(2015).An overview on fluid resuscitation and resuscitation endpoints in burns: Past, present and future. Part 1 -Historical background, resuscitation fluid and adjunctive treatment.Anaesthesiology Intensive Therapy,47(5),6-14.
13. Pinnegar, M. D.,Pinnegar, F. C., 3rd.(1986).History of burn care: A survey of important changes in the topical treatment of thermal injuries.Burns,12(7),508-517.
14. Serrano, C.,Boloix-Tortosa, R.,Gómez-Cía, T.,Acha, B.(2015).Features identification for automatic burn classification.Burns,41(8),1883-1990.
15. Yeong, E. K.,Mann, R.,Goldberg, M.,Engrav, L.,Heimbach, D.(1996).Improved accuracy of burn wound assessment using laser Doppler.Journal of Trauma and Acute Care Surgery,40(6),956-962.

1. 黃弋俽(Yi-Hsin Huang);黃敏勤(Min-Chin Huang);柯薰貴(Hsun-Kuei Ko)(2024)。一位嚴重燒燙傷病人調整身心回歸生活的質性分析。高雄護理雜誌。41(1)。20-32。 
2. 周彥慈(2017)。復原期燒傷病患之身體心像、自尊與社交焦慮。中山醫學大學護理學系學位論文。2017。1-115。