小儿严重烧伤延迟复苏休克期的临床救治

Clinical Treatment of Delayed Resuscitation of Children with Severe Burn at Shock Stage

目的探讨小儿严重烧伤休克期延迟复苏的治疗方法 ,以期提高抢救成功率和治愈率。方法回顾性分析2010年1月—2016年12月武警上海市总队医院烧伤科收治的TBSA25%及以上特重度烧伤且延迟复苏的患儿82例,以晶胶体快速补液、改善微循环、清除氧自由基和早期喂养等方法,观察心率、呼吸频率、每小时尿量及Sa O2、TCO2等指标的变化。结果经治疗该组患儿各项观察指标均获得改善,其中每小时尿量、Sa O2、TCO2各时间段数据经统计学分析差异有统计学意义。补液1 h时患儿尿量(0.5±0.2)m L/(kg·h),氧饱和度(93±1.1)%和TCO2(15±2.1)mmol/L均显著改善,差异有统计学意义(P<0.05)。结论小儿严重烧伤延迟复苏早期快速补液是有效可行的,对延迟复苏的患儿补液不应受公式限制,而应高度"个体化",尽快稳定血流动力学指标,应用药物改善微循环,减轻再灌注损伤,保护脏器功能及早期肠道喂养等有助于延迟复苏救治的成功。

Objective To study the treatment method of delayed resuscitation of children with severe burn at shock stage, in order to improve the success rate and cure rate. Methods 82 cases of severely burned children with delayed resuscitation（burn area ≥25% TBSA） admitted to our hospital from January 2010 to December 2016 were selected, and treated with rapid rehydration of crystal colloid, improvement of microcirculation, clearance of oxygen free radicals and early feeding,and the heart rate, respiration frequency, urinary volume per hour and changes of SaO2, TCO2 were observed. Results After treatment, various observation indicators of patients were improved, and the differences in the urinary volume, SaO2, TCO2 at each time phases between groups were obvious, and the urinary volume, oxygen saturation and TCO2 were obviously improved,[（0.5±0.2）mL/（kg·h）,（93±1.1）%,（15±2.1）mmol/L], and the differences were statistically significant（P〈0.05）. Conclusion Rapid liquid infusion at the early stage in children with delayed resuscitation and severe burns is feasible, which should not be restricted by formula, but we should realize the highly individualization to stabilize the hemodynamics indicators as soon as possible, and the application of drugs, improving the microcirculation, relieving the reperfusion injuries, protecting the organ functions and early intestinal tract feeding contribute to delaying the success of fluid resuscitation.