严重烧伤延迟复苏的快速补液治疗

Clinical Effect of Rapid Fluid Replacement on the Delayed Resuscitation of Patients with Severe Burn Shock

目的：大面积烧伤后，当体液丢失到一定程度便可导致低血容量性休克。延迟复苏会发生休克，需要加以大力复苏。本组病例观察在严重烧伤延迟复苏状况下，在临床上怎样通过补液迅速纠正休克。方法：通过对41例烧伤面积大于50％TBSAⅡ度～Ⅲ度、因延迟复苏导致休克的患者，进行快速补液复苏。观察休克期补液量、尿量、脉搏、呼吸、TCO2等指标的变化。结果：快速补液后2h内输人液体占第一个24h公式计算量的（40．1±5．6）％，第一个24h实际补入量占第一个24h公式计算量的（136．4±18．7）％；第二个24h实际补入量占第二个24h公式计算量的（120.6±5．8）％。快速补液后，尿量大幅增加，TCO2上升，未出现心肺功能不全情况，休克纠正率85％。结论：烧伤休克延迟复苏需要加快补液速度、加大补液量，输液量不受输液公式的限制。快速补液可以迅速纠止休克。临床上通过尿量、脉搏、呼吸，血压变化及血中TCO2水平等临床指标来指导休克延迟复苏是可行的。

Objective： To discuss the clinical effect of rapid fluid replacement on the delayed resuscitation of patients with severe bum shock. Methods： This study included 41 patients inflicted with above 50% TBSA Ⅱ～Ⅲ degree burn, and were in shock due to delayed admission into hospital. The patients were treated by delayed rapid fluid resuscitation. The input of the fluid, urine output, pulse rate, respiration rate, arterial blood pressure, and TCO2 were. monitored at the shock stage. Results： The amount of rapid fluid infusion within 2 hours after adnfission accounted to （40.1 ±5.6） % of the amount calculated with the formula for the first 24 PBHs. The real amount of the fluid for the first 24 PBHs was （ 136.4 ± 18.7） % more than that of the formula amount, and Ihe real fluid arnount for the second 24 PBHs was （ 120.6 ± 5.8） % more than that of the formula amount. After rapid fluid infusion, patients had remarkable increase in urine output, evident increase of TCO2. The shock rectify rate was 85%. Conclusion： In case of shock from delayed resuscitation, the amount of fluid given should be far more increased than routine amount. Rapid fluid resuscitation was beneficial with monitoring urine output, pulse rate, respiration rate, arterial blood pressure and TCO2 and feasible was the correction of burn shock due to delayed resuscitation.