重症烧伤休克期代谢性碱中毒原因分析

Cause analysis of Severe burns shock stage metabolic alkalosis

目的了解重症烧伤休克期代谢性碱中毒(Metabolic alkalosis)的病因、治疗方法以及监测手段等相关因素,以预防其发生。方法收集13例重症烧伤患者自入院至发生代谢性碱中毒发现时所有临床资料,从治疗措施、液体入量及种类、碱性药物、利尿剂、血管扩张剂的应用情况,以及代谢性碱中毒发现后钾入量和盐酸精氨酸的应用情况等方面,比较二氧化碳结合力与血气分析的临床敏感性。结果13例患者休克期第1个24h平均液体总入量达到(3.3±0.80)ml·kg-1·1%TBSA。其中乳酸钠林格氏液(5285±2003)ml,血浆为(3450±2498)ml。13例患者中,在伤后第一天发生代谢性碱中毒的6例患者,均于伤后短时间内应用5%碳酸氢钠125ml～570ml。13例患者休克期分别应用呋塞米、多巴胺、20%甘露醇、利尿,致第1个24h尿量平均达到(125±49)ml。经对血气分析中BE、HCO3与-血CO2-CP同时相、同量标本数监测数据比较,前两者均高于正常参考值,而后者均在正常参考值内。13例患者经积极处理原发病,适当补钾,静脉输入盐酸精氨酸等临床治疗,所有患者的代谢性碱中毒全部得到纠正。结论重症烧伤休克期补液量应在有创和无创监测下平稳达到复苏指标,尿量以1ml·kg-1·h-1为度。患者入院后即行血气分析监测,或可预警代谢性碱中毒的发生。

Objective To investigate cause, therapy and monitoring measures of severe burns with metabolic alkalosis so as to prevent metabolic alkalosis. Methods Therapy measures of 13 severe burns patients were studied from their admission to onset of metabolic alkalosis, including liquid amount and category, usage of alkaline drug, diuretic agent and vasodilator, dosage of potassium and arginine hydrochloride after metabolic alkalosis. The clinical sensitivity of carbon dioxide combining power and blood gas analysis were compared. Results The occurrence of metabolic alkalosis in 13 patients was due to generous fluid supplement in inhibitory stage of shock, usage of alkaline drugs and diuretic agent. Blood gas analysis was a more sensitive monitoring measure than carbon dioxide combining power on metabolic alkalosis. Conclusions Fluid supplement in shock stage should be controlled under invasive or non-invasive monitoring to achieve a smooth recovery. The level of urinary volume should be controlled up to 1 ml · kg^-1 · h^-1. Blood gas analysis should be monitored immediately after the wounded being delivered to hospital. Then metabolic alkalosis may be predicted.