需要气道评估的头颈部烧伤的流行病学与喉镜特征：单中心回顾性队列研究

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中文摘要

背景与目的： 头颈部烧伤是烧伤损伤中临床处理难度较高的一类，因为其可能导致危及生命的气道受损、容貌毁损和心理疾病负担。尽管已有研究提倡对该人群采用系统性可弯曲纤维喉镜进行气道分诊，但来自儿童与成人混合队列的真实世界流行病学和喉镜数据仍然有限，尤其是在高收入西方国家以外。本研究旨在描述在一家土耳其三级烧伤中心因临床怀疑气道受累而接受可弯曲纤维喉镜的头颈部烧伤患者的流行病学特征、解剖分布、喉镜表现及气道管理结局。由于纳入要求存在喉镜检查指征，低风险、孤立性面部烧伤且无气道顾虑的患者未能在本队列中体现，因此所报告的比例不应被解释为人群水平的患病率估计。材料与方法：这项回顾性、单中心观察性研究分析了2022年6月至2024年12月期间在一家三级烧伤中心接受可弯曲纤维喉镜检查的279例头颈部烧伤患者。117例患者（41.9%）的烧伤病因未记录；因此，年龄组之间病因的推断性比较仅限于162例有病因记录的患者，并使用卡方检验。研究期间电子健康记录未系统记录总体表面积（TBSA）和烧伤深度，故无法分析。结果：平均年龄为25.4 ± 22.6岁（儿童43.4%，成人56.6%）。在162例（58.1%）有病因记录的患者中，儿童以烫伤为主（57.4%），而成人以火焰伤（31.9%）和爆炸伤（23.4%）更常见（χ2 = 68.23，df = 4，p < 0.001）；由于其余41.9%的队列病因未记录，该比较应谨慎解读。面部（70.3%）和上气道（42.3%）是最常受累区域。喉镜显示41.2%的患者存在黏膜水肿，19.4%存在充血。4.7%的患者需要气管插管，1.8%需要气管切开；未观察到归因于头颈部烧伤的死亡。结论：由于队列中41.9%的患者病因未记录，尽管达到统计学显著性，所观察到的有记录烧伤病因的年龄相关差异应被视为假设生成性而非确定性结论。同样，由于缺乏标准化烧伤严重程度指标，低气道干预率不能因果归因于喉镜方案，更可能反映该队列异质性且以轻至中度严重程度为主的谱系。这些发现最好被视为描述性和假设生成性结果，强调需要开展具有标准化严重程度记录的前瞻性、多中心研究，以支持头颈部烧伤患者基于证据的气道管理方案。

英文摘要

Background and Objectives: Head and neck burns are a clinically demanding subset of burn injury because of their potential for life-threatening airway compromise, cosmetic disfigurement, and psychological morbidity. Although systematic flexible fiberoptic laryngoscopy has been advocated for airway triage in this population, real-world epidemiological and laryngoscopic data from mixed pediatric and adult cohorts, particularly outside high-income Western settings, remain limited. This study aimed to describe the epidemiological characteristics, anatomical distribution, laryngoscopic findings, and airway management outcomes of patients with head and neck burns who underwent flexible fiberoptic laryngoscopy for a clinical indication of suspected airway involvement at a Turkish tertiary burn center. Because inclusion required a laryngoscopy indication, patients with low-risk, isolated facial burns without airway concern were not represented in this cohort, and the reported proportions should not be interpreted as population-level prevalence estimates. Materials and Methods: This retrospective, single-center observational study analyzed 279 patients with head and neck burns who underwent flexible fiberoptic laryngoscopy at a tertiary burn center between June 2022 and December 2024. Burn etiology was undocumented in 117 patients (41.9%); inferential comparison of etiology between age groups was therefore restricted to the 162 patients with documented etiology, using the chi-square test. Total body surface area (TBSA) and burn depth were not systematically recorded in the electronic health record during the study period and could not be analyzed. Results: Mean age was 25.4 ± 22.6 years (43.4% pediatric, 56.6% adult). Among the 162 patients (58.1%) with documented etiology, scalding predominated in children (57.4%), whereas flame (31.9%) and explosion injuries (23.4%) were more common in adults (χ2 = 68.23, df = 4, p < 0.001); as etiology was undocumented in the remaining 41.9% of the cohort, this comparison should be interpreted with caution. The face (70.3%) and upper airway (42.3%) were the most frequently involved regions. Laryngoscopy showed mucosal edema in 41.2% and hyperemia in 19.4% of patients. Endotracheal intubation was required in 4.7% and tracheostomy in 1.8% of patients; no mortality attributable to head and neck burns was observed. Conclusions: Because etiology was undocumented in 41.9% of the cohort, the observed age-related differences in documented burn etiology should be regarded as hypothesis-generating rather than definitive, despite reaching statistical significance. Similarly, because standardized burn-severity metrics were unavailable, the low airway-intervention rate cannot be causally attributed to the laryngoscopic protocol and more plausibly reflects the heterogeneous, predominantly mild-to-moderate severity spectrum of the cohort. These findings are best regarded as descriptive and hypothesis-generating, underscoring the need for prospective, multicenter studies with standardized severity documentation to support evidence-based airway management protocols in head and neck burn patients.