一例特重度热废机油烧伤并中毒救治的病例报告

A Case Report of Severe Burns and Poisoning Caused by Hot Waste Engine Oil

摘要: 暨南大学附属广州红十字医院烧伤科收治一例30岁男性热废机油烧伤致全身多处80% TBSA，深II~III˚烧伤患者，临床考虑合并中毒。本例患者为大面积特重烧伤，治疗难度极大，需在液体复苏、手术修复创面及处理多器官功能不全、凝血障碍间寻求平衡。休克期采用PICCO血流动力学监测联合无肝素化CRRT治疗；生命体征稳定后，分2次手术清除坏死组织，4次植皮修复创面。经105天救治，患者器官功能恢复，创面愈合出院。热废机油大面积烧伤合并中毒临床罕见，救治需强调：职业防护、接触后彻底冲洗、早期手术阻断毒物吸收、脏器功能支持及血液净化应用。

Abstract: The Burn Department of Guangzhou Red Cross Hospital Affiliated to Jinan University admitted a 30-year-old male patient with extensive (80% TBSA) deep partial-to full-thickness burns caused by hot waste engine oil, with suspected concomitant poisoning. This case presented extreme therapeutic challenges due to the massive burn injury, requiring careful balancing of fluid resuscitation, surgical wound management, and treatment of multi-organ dysfunction and coagulopathy. During the shock phase, hemodynamic monitoring via PICCO was employed in conjunction with heparin-free continuous renal replacement therapy (CRRT). Following hemodynamic stabilization, two staged necrosectomy procedures were performed to remove necrotic tissue, followed by four skin grafting operations for wound reconstruction. After 105 days of comprehensive treatment, the patient achieved restoration of organ function and complete wound healing prior to discharge. Extensive burns due to hot waste engine oil with suspected poisoning are clinically rare. Successful management should emphasize: occupational protection, immediate and thorough decontamination after exposure, early surgical intervention to halt toxin absorption, multi-organ support, and the application of blood purification techniques.