严重烧伤延迟复苏的早期综合救治

Early synthetically treatment on patients with severe burn delayed resuscitation

目的探讨成功救治严重烧伤延迟复苏(烧伤后6 h开始的液体复苏治疗)患者的治疗方法 ,旨在进一步提高延迟复苏患者的救治成功率。方法将72例严重烧伤延迟复苏的患者按不同时期治疗措施的不同分成常规组及综合组,进行比较分析。结果与常规组比较,综合组血清肿瘤坏死因子(TNF)、乳酸(BLA)、肌酸激酶同工酶(CK-MB)下降,碱缺失(BD)上升;其治愈率高,病死率低,心、肺、胃肠等主要脏器并发症发生率及脓毒症发病率明显下降(P<0.01或0.05)。结论快速有效的综合复苏、早期削(切)痂植皮术、及早保护主要内脏器官功能、尽早经肠喂养、扶持机体免疫功能和防治肠源性感染等构成的综合救治方案是提高严重烧伤延迟复苏治愈率的关键。

Objective It is to approach the therapeutic means of patients with severe burn delayed resuscitation,and to increase the probability of successful curing.Methods 72 patients with severe burn delayed resuscitation were divided into synthesized group and routine group,and treated with appropriate measures.Results Compared with routine group,the serum levels of TNF,BLA and CK-MB were evidently lower and DB was evidently higher in synthesized group（P〈0.05 or 0.01）,and the survival rate was evidently higher,the fatal rate was evidently lower,the incidence of sepsis,complication of major visceral organ were evidently lower（P〈0.01 or 0.05）.Conclusion The survival rate increased significantly due to improvement of early rapid and synthesized resuscitation,early escharectomy,protection the function of major visceral organ betimes,early enteral feeding,increased immunity function,avoiding systemic infection and augmentation the treatment for inhalation injury.