严重烧伤创面深度对休克期晶、胶体补液量影响的临床分析

Impact of the depth of wound on fluid replacement in severe burns

目的探讨严重烧伤不同的创面深度对烧伤患者休克期晶、胶体补液量的影响。方法收集2002年10月至2009年1月间青岛市立医院收治的63例烧伤面积大于50%、年龄大于14岁、伤后到入院时间少于6h并且平稳度过休克期的烧伤患者。观察其浅Ⅱ度、深Ⅱ度、Ⅲ度面积(X1、X2、X3)及伤后第1天、第2天的晶体、胶体量。通过数值转换计算出创面因素Y(K×烧伤面积)=(晶体+胶体)/体重,使用SPSS17.0统计软件对浅Ⅱ度、深Ⅱ度、Ⅲ度面积及创面因素进行多元线性回归分析,求得回归方程。经方程转换得到浅Ⅱ度、深Ⅱ度、Ⅲ度面积和体重与补液量的关系。结果自变量浅Ⅱ度、深Ⅱ度、Ⅲ度烧伤面积与因变量创面因素Y呈线性相关,回归方程:第1天为Y=1.370×X1+1.682×X2+1.851×X3;第2天为Y=0.810×X1+0.817×X2+1.184×X3。且总的回归方程及各个自变量均有统计意义,P<0.001。结论大面积烧伤患者早期补液不仅与烧伤面积有关,而且与烧伤深度关系密切。传统的烧伤补液公式应增加烧伤深度因素参数,第1天晶体与胶体补液量(mL)为(1.4×浅Ⅱ度面积+1.7×深Ⅱ度面积+1.9×Ⅲ度烧伤面积)×体重;第2天为(0.8×浅Ⅱ度面积+0.8×深Ⅱ度面积+1.2×Ⅲ度烧伤面积)×体重。

Objective To explore the impact of the depth of wound on fluid replacement during shock stage in severe burns. Methods The data of 63 patients who were burned between October 2002 and January 2009 were callected. All the patients were above fourteen years old, the burned areas were larger than 50%, and the time after burned was less than six hours. All of the patients passed through shock stage smoothly. we recorded the extent of different depths and the volume of crystal and colloid in the first two days of each patient, calculated the factors of wound Y （K×burned area） = the volume of crystal and colloid/ weight, analyzed the relationship between depth of wound and the capacity of crystal and colloid through statistical software Spss17.0, and figured out the regression equation. We got the relationship between the depth of wound,weight and the volume of crystal and colloid by equation transformation. Results There was line relationship between the depth of wound and the volume of crystal and colloid. The regression equation of the first day was Y=1.370×X1＋1.682×X2＋1.851×X3. The second day was Y=0.810×X1＋0.817×X2＋1.184X3. The general regression equation and all independent variables were significant, P﹤0.001. Conclusions There is close relationship among the volume of fluid resuscitation and the area of burns and the depth of wound in extensive burn patients. The traditional formula of resuscitation should consider the factor of the depth of wound. The supplement of crystal and colloid in the first day is （1.4×second-degree shallow burn area＋1.7×second-degree deep burn area＋1.9×third-degree burn area）×weight; in the the second day is （0.8×second-degree shallow burn area ＋0.8×second-degree deep burn area ＋1.2×third-degree burn area）×weight.