应用MEBT治疗80例大面积烧伤休克病人的体会

Experience with MEBT in Treating 80 Cases of Large Area Burn and Shock

本文报导了应用MEBT80例大面积烧伤休克的治疗过程，认为：①创面无疼痛，防止了疼痛性休克的发生；②创面被MEBO覆盖减少了水份蒸发；③创面湿润防止了Ⅱ°烧伤加深并改善创面微循环。故休克容易纠正，尿量多。总结出烧伤输液公式：成人烧伤面积％×体重×1．6＋2500ml，小儿烧伤面积％×体重×1．8十体重×100ml。第一个24小时胶晶比1：1，第二个24小时胶晶比1：2。在伤后2小时内输完总量1／4，伤后4小时以内输入总量的1／2，余1／2量在后16小时均匀输入。轻、中度休克病人休克期度过平稳，重度休克病人先用生理盐液按20－40ml／kg扩容，待休克纠正后，仍用公式估计液体量在伤后24小时输入。后24小时则按公式要求输。尿量成人保持在100ml／h以上，小儿在30ml／h以上，红细胞压积在50％以下。强调快速补液是抗休克成功的重要前题。同时早期应用654—Ⅱ，甲氰咪胍、复方丹参有利于对抗自由基对内脏的损伤，提高抗休克的疗效。在抗休克纠正酸中毒，改善微循环方面作者也详细介绍了自己的临床经验。

80 cases of large area burn complicated by shock were treated with MEBT. The treating course is de-scribed as follows:1. No pain, pain shock was avoided.2. Wounds were covered with MEBO. Water e-vaporation was reduced.3. Wounds were kept in moist environment with no further injury to the wound.4. MicrocircuIation was improved and shock was easy to correct. Fluid infusion volume was calculated according to the formula:For adults: Burn area % x body weight (Kg) x 1. 6+2, 500 mlFor children: Burn area % x body weight(Kg) x 1. 8+body weight(Kg) x 100mlln the first 24 hours, colloids: crystalloids=1: 1. Inthe second 24 hours, colloids: crystalloids= 1: 2.1/4 of the total infusion volume was infused in 2 hours post-burn- 1/2 of the total in 4 hours post-burn an-other 1/2 was infused uniformly in the later 16 hours.Patients with slight and moderate shock tided over their shock stage smoothly. Patients with severe shock had to enlarge their blood volume by infusing 20 to 4o ml/kg of normal saline, After correction of shock, fluid infusion was carried out according to the above stated formula in 24 hours post-burn. After 24 hours post-burn, the infusion was carried out accord-ing to the formula. For adults, urine output was kept above 100 ml/hour and for children 30 ml/hour.Hematocrit was kept below 50%. Timely and rapid in-fusion is key to the success of shock treatment- Early administration of 654 - 11, cimetidine and compound red sage root is beneficial to protection of organs from free radical damage and promotion of the efficacy of antishock measures.The authors also introduced their experience in correcting acidosis and improving microcirculation