严重烧伤患者休克期实施多指标综合监测的临床研究

A clinical research on combined multi-index monitoring in patients in shock stage from severe burn

目的探讨严重烧伤患者休克期可行的监测指标及监测方法,提高休克期抢救成功率。方法成立重症监护病房(BICU),选择可靠实用的监测指标并制定其安全范围及预警界限。对2000年9月至2008年12月收治的482例特重烧伤患者(研究组)实施多指标监测,指导休克期输液。与1997年1月至2000年8月收治的217例特重烧伤患者(对照组)对比,统计两组患者实际输液量,得出输液公式;统计并发症发生率,比较两组疗效,对各项数据进行统计学处理。结果在多指标综合监测下,研究组较对照组各年龄段患者的输液量均增加(输液常数较补液公式中的输液常数增加),差异具有统计学意义(P<0.01)。研究组较对照组并发症发生率降低、抢救成功率提高,差异具有统计学意义(P<0.01)。结论严重烧伤患者休克期监测对休克救治具有重要意义,要选择可靠实用的指标进行监测,综合分析判断病情。既往的输液量偏低,可能存在隐匿性休克。

Objective To explore a feasible method and useful monitoring indices for patients in shock stage from severe burn so that higher success rate of rescue can be achieved.Methods Intensive care unit wasestablished and reliable monitoring indices with relative safety rangeand warning boundary were selected.This multi-index monitoring method was applied on the 482 patients with severe burn（study group）,collected from September 2000 to December 2008,to guide the fluid resuscitation in these patients during the shock stage.Actual volume of fluid was calculated to produce the transfusion formula used in guiding the resuscitation.Complication rate was also analyzed and compared to that summarized from cases from January 1997 toAugust 2000 （control group）.Data were analyzed using statistic method.Results Using this monitoring method,it was found that more fluid was needed in patients with severe burn compared to control.The complication rate was decreased and the success rate of rescue was increased in these patients.The difference was statistically significant.Conclusions The multi-index monitoring in patients suffering severe burn during the shock stage is an important guidance for rescue. Reliable indices should be carefully selected for effective monitoring.Previous opinion in fluid volume for transfusion may be suboptimal which can cause occult shock.