中心静脉导管置入与中心静脉压监测在危重烧伤早期补液治疗中的应用

Application of central venous catheterization and central venous pressure to burn shock

目的寻求危重烧伤早期简便、快速、有效的补液治疗方案。方法对2002-07－2009-07收治的15例危重烧伤患者立即行锁骨下深静脉置人中心静脉导管，以此作为快速补液通道，同时床旁安装简易中心静脉压（CVP）监测装置，根据CVP监测结果，结合尿量、心率、呼吸及意识等无创监测指标调节补液；计算伤后第1个24h和第2个24h补液量；根据补液公式：品胶体总量=面积×体质量×k，换算出k值（k为晶胶体系数）。结果15例危重烧伤患者休克期平稳度过。伤后第1个24h补液总量为（10963±1062）mL，晶体（5321±983）mL，胶体（4013±887）mL，5％葡萄糖（2754±753）mL，k=1.7－2.0。第2个24h输液总量为（8135±725）mL，晶体（3356±652）mL，胶体（2953±375）mL，5％葡萄糖（2584±804）mL，k=1.3－1.5。结论中心静脉导管置入与中心静脉压监测运用于危重烧伤早期补液治疗，方法简便、疗效确切。

Objective To explore a convenient, quick and effective fluid replacement solution by the application of central venous catheterization and central venous pressure（CVP） in the early period of severe burn shock. Methods From July 2002 to July 2009, fifteen patients with severe burn was enrolled. After the patients were transferred to the ward, both central venous catheterization and central venous pressure （CVP） were carried out. According to the results of CVP, urine volume, heart rate, respiratory frequency and consciousness, the volume of fluid was calculated during the first 24 h and second 24 h. Fluid replacement formula lists were as follows：the total fluid volume = BSA（body surface area with burn）×body weight ×k（k is a coefficient）. Results All the 15 cases recovered from burn shock. During the first 24th hour,the average fluid volume was （10963±1062）mL[crystal solution was（5321±983）mL,colloidal fluid was （4013±887）mL,k = 1.7-2.0. During the second 24 hour,the average fluid volume was （8135±725） mL [crystal solution was （3356±652）mL, colloidal fluid was （2953±375） mL, k=1.3- 1.5]. Conclusion Application of central venous catheterization and CVP monitoring is a effective method in treating the serious burn patients during early shock period.