输入量与尿量比在深Ⅱ度烧伤患者休克预防性补液中的临床价值

The clinical vatue of input volume/urine volume ratio in the prevention of fluid infusion in patients with deep partial burn

目的探索时段性观察输入量与尿量之比,对深Ⅱ度烧伤患者休克预防性补液的指导价值。方法选取大面积烧伤成人患者13例作为A组,入院时无尿,加上情况紧急,为了迅速补液以防休克,采用了传统烧伤公式计算补液量,24 h后的补液则根据输入量与尿量比,在公式计算的基础上进行调整;按照随机数表法选取15例患者(均为个体烧伤)为B组,在传统烧伤公式计算量的基础上,根据患者输入量与尿量比进行补液调整;于48 h后监测两组患者的Na+浓度、K+浓度、心率、血压等指标,并采集股静脉血检测主要脏器功能,以此评价根据输液量与尿量比指导补液的可行性。结果第1个24 h:补液量/尿量:A组为(2.8±0.7),B组为(3.6±0.4),两组比较,差异具有统计学意义(P<0.05);第2个24 h:补液量/尿量:A组为(1.82±0.5),B组为(1.75±0.7),两组比较,差异无统计学意义;48 h后,监测患者的Na+浓度、K+浓度、心率、血压等指标,并采集股静脉血检测主要脏器功能,除HCT外,两组患者的其余指标比较,差异均具有统计学意义(P<0.05)。结论在医疗设备及医务人员数量有限制、患者无尿等紧急情况下,为了迅速补液防止休克,可以谨慎采用公式计算补液量,方便易行,但是后期必须迅速调整补液量,注重恢复患者主要脏器功能;若情况允许,开始治疗时就观察输入量与尿量之比适时调整补液量,能显著降低烧伤患者主要脏器功能受损的风险。

Objective To explore the clinical study of the input volume and urine volume in the prevention of fluid infusion in patients with deep partial burn. Methods A total of 13 cases adult patients with major burns in our hospital as group A： no urine and emergency,in order to rapid rehydration to prevent shock,using traditional burn formula to calculate the amount of fluid,24 hours after the infusion according to the input volume and urine volume ratio,adjusted basis in the formula; 15 patients（ all individual burns） were selected as the group B： based on the traditional formula and the amount,according to the input and the urine volume to adjust the amount; after 48 h monitoring two groups＇ Na＋concentration,K＋concentration,heart rate and blood pressure. And collect the femoral vein blood testing main organ index,to evaluate the effect of infusion quantity and urine volume for guiding fluid infusion. Results In the first 24 hours： the amount of fluid / urine volume： group A for（ 2. 8 ± 0. 7）,group B was（ 3. 6 ± 0. 4）,the difference of the two groups had statistical significance（ P〈 0. 05）; the second 24 hours： fluid volume / volume of urine in group A was（ 1. 82 ± 0. 5）,group B was（ 1. 75 ± 0. 7）. The difference between the two groups had no significant（ P〉 0. 05）; after 48 hours,with monitoring the concentration of Na ＋,K ＋ concentration,heart rate,blood pressure and other indicators,and the acquisition of femoral venous blood samples to detect the functions of major organs,with the exception of HCT,the rest of the index of two groups of patients had statistical difference（ P〈 0. 05）. Conclusion If there are limited in the number of medical equipment and medical personnel,patients with urinary,in order to rapid fluid replacement from shock cautious,we can use the formula to calculate the amount of fluid and it is convenient,but the latter we must quickly adjust the amount of fluid and pay attention to the recovery of patients with major organ function. At the beginning of treatment,we should observe the urinary output and input ratio to adjust the amount of fluid,it can significantly reduce the risk of impaired function of main organs in burn patients.