Objective To retrospectively explore the effects of modified dosage of calcium gluconate (CG) on the patients with hydrofluoric acid burns not in hands or feet.Methods One hundred and sixty patients with hydrofluoric acid burns not in hands or feet were hospitalized in our burn ward from January 2004 to December 2017.Based on the dosage of CG at different admission time,76 patients hospitalized from January 2004 to December 2012 were included in traditional group,and 84 patients hospitalized from January 2013 to December 2017 were included in modified group.For patients in the two groups,subcutaneous injection of CG solution at one time was immediately conducted on admission in topical treatment.In traditional group,the injection was CG solution with mass concentration of 100 g/L.For wounds of superficial partial-thickness and above degree,CG solution was prescribed at the dosage of 50 mg/cm2.Wounds of superficial-thickness or mass fraction of hydrofluoric acid less than 20.0％ did not receive injection.In modified group,the mass concentration of CG solution for injection was diluted with normal saline to 25 g/L.For wounds of deep partial-thickness and above degree,CG solution was prescribed at the dosage of (50 × mass fraction of hydrofluoric acid) mg/cm2.For wounds of superficial partial-thickness,CG solution was prescribed at the dosage of (25 × mass fraction of hydrofluoric acid) mg/cm2.For wounds of superficial-thickness,CG solution was prescribed at the dosage of 2.5 mg/cm2.For systemic treatment,the injection velocity of CG solution via venous access was adjusted according to the level of serum calcium namely total serum calcium of patients in traditional group.In modified group,serum ionized calcium was additionally detected through automatic blood gas analyzer by the bed to regulate the injection velocity of CG via venous access.The incidence rate of hypercalcemia and mortality of patients after treatment in the two groups,and the situation about treatment of survivors in the two groups were analyzed.Data were processed with chi-square test,Fisher's exact probability test,t test,and Mann-Whitney U test.Results (1) After treatment,9 patients (11.8％) had hypercalcemia,while the other 67 patients (88.2％) did not have hypercalcemia in traditional group.Two patients (2.4％) had hypercalcemia,while the other 82 patients (97.6％) did not have hypercalcemia in modified group.The incidence rate of hypercalcemia of patients in traditional group was significantly higher than that in modified group (x2 =5.579,P =0.02).(2) There were two deaths (2.6％) and 74 survivors (97.4％) in traditional group,while there were two deaths (2.4％) and 82 survivors (97.6％) in modified group.The mortalities of patients in the two groups were close (P ＞0.05).(3) The ratios of eschar excision and skin grafting and hyperplastic scar formation,wound healing time,and ratio of esophageal scar stenosis of survivors in the two groups were close (x2 =0.002,0.054,Z =0.66,P ＞ 0.05).Conclusions Hydrofluoric acid is highly dangerous.The early management of patients with hydrofluoric acid burns emphasizing specialized dosage of CG for treatment can be helpful to reduce incidence of complications and improve the safety of treatment.%目的 回顾性探讨改良葡萄糖酸钙(CG)给药剂量对非手足部的氢氟酸烧伤患者的治疗效果. 方法 2004年1月-2017年12月,笔者单位收治160例非手足部的氢氟酸烧伤患者.根据不同时期CG剂量,将2004年1月-2012年12月入院的76例患者设为传统组,201 3年1月一2017年12月入院的84例患者设为改良组.局部治疗中,2组患者入院时立即于创面一次性皮下注射CG溶液,传统组患者注射液为质量浓度100 g/L的CG溶液,浅Ⅱ度及以上深度创面按50 mg/cm2计算剂量,Ⅰ度创面及致伤氢氟酸质量分数低于20.0％者不注射;改良组患者注射液为采用生理盐水稀释的质量浓度25 g/L的CG溶液,按照深Ⅱ度及以上深度创面(50×氢氟酸质量分数)mg/cm2、浅Ⅱ度创面(25×氢氟酸质量分数)mg/cm2、I度创面2.5 mg/cm2计算剂量.全身治疗中,传统组患者根据血钙即血总钙水平调整静脉CG溶液注射速度,改良组另加用全自动血气分析仪床旁检测血游离钙水平,并以此调整静脉CG溶液注射速度.统计2组患者治疗后高钙血症发生率、病死率及存活患者的治疗相关情况.对数据行x2检验、Fisher确切概率法检验、t检验、Mann-Whitney U检验.结果 (1)治疗后,传统组有9例(1 1.8％)患者发生高钙血症,67例(88.2％)患者未发生高钙血症;改良组有2例(2.4％)患者发生高钙血症,82例(97.6％)患者未发生高钙血症.改良组患者高钙血症发生率明显低于传统组(x2=5.579,P=0.02).(2)传统组2例(2.6％)患者死亡,74例(97.4％)患者存活;改良组2例(2.4％)患者死亡,82例(97.6％)患者存活.2组患者的病死率相近(P＞0.05).(3)2组患者中存活者创面切痂植皮术比例、增生性瘢痕比例、创面愈合时间、食道瘢痕狭窄比例相近(x2 =0.002、0.054,Z=0.66,P＞0.05). 结论 氢氟酸烧伤具有高度危险性,早期采用个体化剂量的CG治疗有助于减少并发症,提高治疗的安全性.
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