重视烧伤早期液体复苏循环状态研究

Lay emphasis on circulatory state research after fluid resuscitation in early burns

国际烧伤学会（ISBI）于2016年在美国迈阿密召开的大会上发布了依据循证医学研究结果制订的烧伤治疗指南，将Parkland公式作为预防烧伤早期低血容量性休克的推荐公式。该指南提出：相对电解质溶液而言，尚无证据证明采用大量胶体溶液进行液体复苏时患者受益更多，且胶体溶液价格昂贵；另外，由于95%的烧伤发生在烧伤救治资源有限的发展中国家，ISBI推荐以电解质溶液为基础的初始液体复苏方案是为适应大多数国家烧伤情况。笔者认为，在大面积深度烧伤患者存活率尚未大幅度提高的情况下，简单依据烧伤治疗指南否定中国烧伤液体复苏公式的做法有待商榷。有研究表明，在应用电解质溶液进行烧伤早期液体复苏基础上，加入胶体溶液后，发生液体泛滥（fluid creep）的风险较低。该指南将液体复苏溶液选择中的胶体、电解质溶液争议呈现在中国学者面前，需要学术界梳理烧伤早期液体复苏发展历史、烧伤病理生理学、重症医学临床和基础研究进展，重视采用目前国际公认临床和基础研究方法，从循环驱动力、微循环灌注和细胞氧合等循环指标监测入手，评估胶体、电解质混合溶液进行早期液体复苏的中国方法的疗效，探讨在血液资源紧缺情况下，烧伤早期液体复苏方法是否有优化空间。

In this article, we discuss future development of circulatory state research after fluid resuscitation in early burns from its history and difficulties confronted. We believe that the Chinese fluid resuscitation formula to predict initial volume of fluid infusion of extensive burn patients is still useful and effective, while we should attach more importance to advances in the research of burn pathophysiology, basic theory and clinical practices of Chinese fluid resuscitation formula, so as to provide strategy of fluid resuscitation in early burns for international burn world. We should know clearly circulatory state of patients from circulatory driving force, microcirculation, and cell oxygenation. Besides, multidisciplinary cooperation should be strengthened, such as promoting communication and technological convergence between burn discipline and critical care discipline, to make preparation for future of intelligent and individualized fluid resuscitation.