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烧烫伤的程度划分:一、I度烧烫伤（红斑性烧伤）:伤及皮肤表皮，表现为受伤处皮肤轻度红、肿、热、痛，感觉过敏，无水泡;3-7天愈合，不留瘢痕。二、（1）浅II度烧烫伤（水疱性烧伤）:伤及真皮乳头层，水疱较大，疱壁厚，基地潮湿，表现为受伤处皮肤疼痛剧烈、感觉过敏，有水泡;水泡拨离后可见创面均匀发红、潮湿、水肿明显;2周愈合，不留瘢痕，可有色素沉着。（2）.深II度烧烫伤:伤及真皮深层，创面水疱较小、疱壁厚，去皮后基地红白相间，可见网状血管栓塞。表现为受伤皮肤痛觉较迟钝，可有或无水泡，基底苍白，间有红色斑点;拔毛时可感觉疼痛;3-4周痊愈，留有瘢痕。三、III度烧烫伤（焦痂性烧伤）:伤及皮肤全层，达肌肉或骨骼层，皮肤感觉消失，无弹性，干燥，无水泡，蜡白、焦黄或碳化;拔毛时无疼痛。严重的烧伤不仅损伤皮肤，还可深达肌肉、骨骼甚至引起全身变化如休克感染等。愈合慢，愈合后疤痕增生。BurnClassificationNote:Thelistbelowshows4burndegrees.Whilemostofthepublicdoesnotrecognizethe4thdegree,itisthecorrectterm.Thetablebelow,with3degrees,isalsocorrect.Bothareacceptable.Determiningburndepthisimportant.Thingstoconsideraretemperature,mechanism,durationofcontact,bloodflowtoskin,andanatomiclocation.Epidermaldepthvarieswithbodysurface,whichcanoffervaryingdegreesofthermalprotection.Olderadultsandyoungchildrenalsohavethinnerskin.Firstdegree:Includesonlytheouterlayerofskin,theepidermisSkinisusuallyredandverypainfulEquivalenttosuperficialsunburnwithoutblistersDryinappearanceHealingoccursin3-5days,injuredepitheliumpeelsawayfromthehealthyskinHospitalizationisforpaincontrolandmaybefluidimbalanceSeconddegree:Canbeclassifiedaspartialorfullthickness.PartialthicknessBlisterscanbepresentInvolvetheentireepidermisandupperlayersofthedermisWoundwillbepink,redincolor,painfulandwetappearingWoundwillblanchwhenpressureisappliedShouldhealinseveralweeks(10-21days)withoutgrafting,scarringisusuallyminimalFullthicknessCanberedorwhiteinappearance,butwillappeardry.InvolvesthedestructionoftheentireepidermisandmostofthedermisSensationcanbepresent,butdiminishedBlanchingissluggishorabsentFullthicknesswillmostlikelyneedexcision&skingraftingtohealThirddegree:AlllayersoftheskinaredestroyedExtendsintothesubcutaneoustissuesAreascanappear,blackorwhiteandwillbedryCanappearleatheryintextureWillnotblanchwhenpressureisappliedNopainFouthdegree:Fullthicknessthatextendsintomuscleandbone.Burninjuryisthedestructionofthelayersoftheskinandassociatedstructures.AnatomyofSkin:烧伤的致伤原因1，热力（热水、蒸汽、火焰）2，化学物质（强酸、强碱）3，电4，放射线烧伤的病理生理分期1，休克期：伤后48-72h内–大量体液渗出，2-3h最快，8h达到高峰，48h开始回吸收，此期易发生低容量性休克。2，感染期：72h后–皮肤生理屏障被破坏。创面、渗液黎宇细菌生长繁殖，产生毒素。感染烧伤创面脓毒症。3，修复期：伤后5-8天开始–I度烧伤，3-7天自行修复。浅II度烧伤，2周愈合，有色素沉着。深II度烧伤，3-4周愈合，留有瘢痕。III度烧伤，靠皮肤移植修复，留有瘢痕，影响功能。临床表现和诊断1，烧伤面积：手掌法：伤员本人五指并拢的手掌面积为体表总面积的1%,五指自然分开的手掌面积为1.25%，适用于小面积烧伤的评估。2，九分法：烧伤的严重程度：根据烧伤深度与面积判断轻度烧伤：Ⅱ°面积9%中度烧伤：Ⅱ°面积10%-29%Ⅲ°面积不足10%重度烧伤：总烧伤面积达30%-49%或Ⅲ°面积达10%-19%Ⅱ°、Ⅲ°烧伤并休克、吸入性损伤特重烧伤：总烧伤面积50%Ⅲ°20%或已有严重并发症吸入性损伤诊断依据：*吸入火焰、蒸汽、浓烟等*燃烧现场相对封闭*口鼻周围、面、颈部有深度烧伤*呼吸道刺激症状：声哑、呼吸困难、哮鸣音、咳炭末样痰特殊类型烧伤的特点1，电击伤：“入口”损伤比“出口”严重“入口”皮肤焦裂样洞穴出入口之间深部组织不规则进行性坏死局部反应重、全身反应轻2，化学烧伤硫酸、硝酸、盐酸、石碳酸等少见水疱皮革样焦痂创面蜡白/青灰色疼痛剧烈