特重烧伤患者休克期补液与血钠变化分析

Anaysis on fluid infusion and change of serum sodium of severely burned patients in shock stage

目的观察特重烧伤患者休克期电解质与胶体溶液复苏量及其比值和血钠变化,探讨合理的补液方案。方法取2007年1月-2011年1月本院收治的烧伤总面积大于50%、III度面积大于20%TBSA的42例进行液体复苏的患者,总结患者伤后24、48、72h电解质和胶体的补充量及尿量的变化,观察患者不同时间段补液及血钠变化,并进行统计学分析。结果 42例患者中,29例血钠正常,4例出现高钠血症,9例休克期出现低钠血症。患者伤后72h内尿量均在50ml/h以上。患者实际补的电解质+电解质胶体总量(ml)=烧伤总面积(%TBSA)×体重(kg)×K,公式中的K值在伤后第一个24h约为1.8,电解质与胶体比值约为1.4;伤后第二个24h的K值为1.1,电解质与胶体比值为1.3;伤后第三个24h的K值为0.8,电解质与胶体比值为1.8。结论特重度烧伤患者休克期实际液体补入电解质与胶体总量大于国内传统公式计算量(伤后第一个24h的K值为1.5)。休克期补入电解质量及电解质与胶体比值对血钠变化有一定的影响。

Objective To observe the amount of electrolyte and colloidal solution during shock stage in serverly burned patients,the ration of electrolyte and colloidal solution and the change of serum sodium,and to discuss using the reasonable solution.Methods 42 patients with total burn surface area（TBSA） greater than 50% or III degree burn surface area greater than 20%TBSA in our hospital from January 2007 to January 2011 were selected to do fluid resuscitation.To summay the changes of electrolyte,colloid and urinary ouput of patients after injury 24,48 and 72 hour of injury.The changes of serum sodium and fulid infusion were recorded in different times and data were statistically analyzed.Results In 42 patients,29 patients had normal serum sodium value,and hypernatremia occurred in 4 patients and hyponatremia occurred in 9 patients during shock stage.The urinary ouput of patients after 72 hour of injury were greater than 50ml/h.The formula：The totally amount of electrolyte ＋ colloid（ml） = total area burned（%TBSA） × body weight（kg） × K.In this first 24 h,the value of K is about 1.8 and the ratio of electrolyte and colloid is about 1.4.In this second 24 h,the value of K is about 1.1 and the ratio of electrolyte and colloid is about 1.3.In this third 24 h,the value of K is about 0.8 and the ratio of electrolyte and colloid is about 1.8.Conclusion The actually total amount of electrolyte and colloid to serverly burned patients in shock stage is greater than the traditioal formula（In this first 24h,K value is about 1.5）.The amount of electrolytes and the ratio of electrolyte and colloid will influence serum sodium of patients.