“容量补充”加“动力扶持”——烧伤休克有效复苏方案的思考

＂Volume replacement＂ plus ＂dynamic support＂：a new regimen for effective burn shock resuscitation

休克是严重烧伤后早期重要的并发症之一。1863年就有学者提出血流不足是烧伤死亡的主要原因。经过长时间大量的临床与实验研究，人们虽然对烧伤休克的原因及病理生理变化有了较为清楚的认识，对一般休克的临床防治也形成了一套较为成熟的液体复苏方案。但许多严重烧伤患者特别是延迟入院者，不仅难以避免休克，而且复苏效果也不满意，常造成组织器官较长时间的缺血缺氧，引起功能不全甚至衰竭，导致患者死亡。因此，寻求更为有效的烧伤休克防治方案，仍是当前烧伤救治的关键问题。

It is well known that shock is one of the main complications occurring during early stage of severe burn, and presently, ischemic/hypoxic damage of tissues and organs is still hard to be prevented by various fluid resuscitation regimens. Findings in recent years demonstrated that postburn cardiac damage occurs promptly and much earlier than any other organs. Application of measures to ameliorate cardiac damage may improve organ blood flow in liver, kidney, and intestines, and mitigate organ damage concomitant with fluid resuscitation according to Parkland formula. These facts suggest that cardiac damage occurring promptly at early stage of severe burn is one of the important factors leading to ischemia/hypoxia of tissues and organs, therefore, new resuscitation regimen including ＂volume replacement＂ plus ＂dynamic support＂ may conduce to more effective burn shock resuscitation, and reduce organ complications as a resuh of either insufficient or over fluid infusion.