ISPN/RN考试中可能会出现计算烧伤面积的题目，因为在美国这项工作是急诊及相关科室的护士负责。今天这篇文章就给大家分享一下烧伤Burn的分度以及解答这类题目的技巧。

烧伤的分度依据的是损伤的深度

Superficial Thickness(1st degree)Ⅰ度烧伤

临床表现:

Epidermis only 表皮损伤

No blistering 不起疱

Dry, red, slightly swollen 创伤处干燥、红肿

Blanches to pressure 压之褪色

Painful to touch 触痛

Heals spontaneously Healing time is 3-7 days 3-7天自行愈合

No scarring 不留瘢痕

Superficial-Partial Thickness(2nd degree)浅Ⅱ度烧伤

临床表现

Entire epidermis and upper level dermis is lost伤及整个表皮及真皮浅层

Intact blisters水疱

Moist, weeping 创伤处湿润、渗出

Blanches to pressure 压之褪色

Hypersensitive to touch 触之剧痛

Heals rapidly and spontaneously in 1-2 weeks due to good blood supply 无感染1-2周自愈

Scarring is uncommon 不留瘢痕

Deep-Partial Thickness(deep 2nd degree)深Ⅱ度烧伤

临床表现

Epidermis and severe damage to dermis伤及真皮乳头层以下

no blisters 没有水疱

Blotchy whitish，wet or waxy 伤口呈湿润或蜡样的灰白色

Some loss of sensation so less painful 因为感觉神经末梢受损，不怎么疼

Healing is sluggish(greater than 2 weeks, 4-6weeks)愈合缓慢，超过两周，一般要4-6周

Scarring and contractures可留瘢痕和瘢痕收缩引起的局部功能障碍

Could benefit from skin grafting 最好是进行皮肤移植

Full Thickness&Subdermal(3rd-4th degree)Ⅲ-Ⅳ度烧伤

临床表现

Complete loss of epidermis and dermis, even subcutaneous fat, muscles,bone全层皮肤烧伤，可深达皮下组织、肌骨

White and waxy to charred black 创面蜡白甚至炭化

Insensate-no pain 无痛觉

Markedly decrease in blood flow 创面血供明显减少

Susceptible to infections 极易发生感染

High risk of hypertrophic scarring and contractures 多形成瘢痕，且常造成畸形

Pruritis(itching)is a common complication during rehabilitation 愈合过程巨痒

Must do surgical intervention 必须手术干预

烧伤面积的计算，一般用的是“九分法”

大家可以这样记，做题非常好用：

Head 9% (face 4.5%)

Chest 9%

Abdomen 9%

Upper back 9%

Lower back 9%

Front left leg 9%

Back left leg 9%

Front right leg 9%

Back right leg 9%

Left arm 9%

Right arm 9%

Genitalia 1%

当然这是针对成人来说的，大家都知道，宝宝的身材比例不同，头往往占更大的面积，腿占比例相对缩小。不过掌握上述解题技巧对有ISPN/RN考试就足够用了。实际临床上护士做评估一般是使用改良后的“伦-勃法”，也就是把头、大腿和小腿设置了三个变量，按照年龄和公式去推算。