严重烧伤休克期不同时间段血清阴离子的变化

The change of serum anion at various times postburn in severely burned patients during shock stage

目的探讨严重烧伤休克期不同时间段血清阴离子发生变化的原因和机制，为临床休克期补液提供依据。方法对1996年1月-2002年10月间121例重度以上烧伤患者休克期不同时间段的306次同步血气分析与电解质的结果进行回顾性分析。结果①严重烧伤休克期患者的血清阴离子隙（AG）、碳酸氢根离子（HCO3^-）与氯离子（Cl^-）在休克期不同时段的变化是明显的，与对照组比较，血清HC03^-在0—8、8—16、16～24与24—48h降低差异有显著性（P〈0．01，P〈0．05），血清AG在0～8、8—16、16—24与24～48h增加的差异有显著性（P〈0．01，P〈0．05），两者在48—72h变化的差异无显著性；血清Cl^-在0～8、8—16与16—24h变化的差异无显著性，在24～48与48—72h下降的差异有显著性（P〈0．01），其与血清Na^＋的变化一致。②休克复苏液中晶体液的百分含量在8h以后呈下降趋势。结论严重烧伤休克期不同时间段血清阴离子的变化是明显的，血清AG增加与血清HCO3^-降低呈正相关，说明严重烧伤休克期的早期为高阴离子间隙性酸中毒。血清Cl^-的变化与血清钠离子的变化一致，与不同时间段补充晶体复苏液的含量有关。

Objective To investigate the changes and causes of serum anion at various times in severely burned patients during shock stage. Methods A total of 121 patients with severe burns in the shock stage, which were admitted from 1 January 1996 to 31 October 2002, were examined with concomitant arterial blood gas and electrolyte panel for 306 times in this study. Results The means of serum anion gap of all study groups other than 48 ~ 72h group were significantly increased, as compared with that in the control group（P 〈0. 01 ）. The means of serum bicarbonate ion of all study groups other than 48 ~ 72 h group in severely burned patients were significantly lower than that of the control group（P 〈0. 05 or P 〈0. 01 ）. The means of serum chlorine ion of all study groups other than 0~8 h group were significantly lower than those of the control group （P 〈0. 05 or P 〈0. 01 ）. The tents of shock resuscitation fluid trended to descend after eight hours postburn. Conclusion The anion in severely burned patients during shock stage are obvious. The content of serum chlorine scend after eight hours postburn, which is associated with lossing over serum electrolytes, infusing electrolytes conchanges of serum ion trends to deless serum elec- trolytes and diluting blood volume. The anion gap trends to increase and the serum bicarbonate ion descend from 0 ~ 8 h to 24 ~ 48 h postburn because of shock, circulation volume shortage, organization anoxia and sugar anaerobic metabolism strengthen consumedly.