烧伤吸入性损伤合并酒精中毒患者休克期液体管理探讨

Approach on fluid management in shock stage of burn patients with in halation injury and alcoholism

目的:探讨酒精中毒合并烧伤和吸入性损伤患者休克期液体复苏的特点。方法:回顾性分析2017年1月—2021年4月郑州市第一人民医院收治的单纯烧伤(A组,n=53)、酒精中毒合并烧伤患者(B组,n=42)、酒精中毒合并烧伤及吸入性损伤(C组,n=32)患者的液体复苏资料。比较3组患者伤后48 h休克期总输液量、平均每小时尿量以及肺水肿、急性呼吸窘迫综合征(ARDS)、急性心肌损伤、恶性心律失常等并发症的发生率。结果:3组患者年龄、烧伤面积及体质量差异均无统计学意义(P>0.05)。休克期内C组补液量较A组和B组高,B组较A组高(P<0.05);C组肺水肿、ARDS发生率远高于A组和B组(P<0.05);急性心肌损伤发生率、恶性心律失常发生率C组最高,A组最低(P<0.05)。伤后48 h平均每小时尿量比较,A组与B组差异无统计学意义(P>0.05),C组低于A组和B组(P<0.05)。结论:普通烧伤患者经过常规补液治疗后基本能获得满意的尿量并纠正休克,但仍存在相关的并发症如肺损伤及心肌损伤。酒精中毒合并烧伤和吸入性损伤的患者休克期无论在补液量及肺水肿、ARDS、恶性心律失常、急性心肌损伤的发生率都高于普通烧伤患者,且易发生顽固性休克、重度ARDS、恶性心律失常而导致患者死亡,故应引起临床医师重视,应密切监护,并放宽相应的补液量从而降低患者的病死率。

Objective:To investigate the characteristics of fluid resuscitation in shock stage of burn patients with inhalation injury and alcoholism.Methods:the fluid resuscitation data were retrospectively analyzed of 53 patients with simple burn(group A),42 burn patients with alcoholism(group B)and 32 burn patients with inhalation injury and alcoholism(group C)admitted and treated in Zhengzhou First People’s Hospital from Jan.2017 to Apr.2021.The total infusion volume,average urine volume per hour and the incidence of complications such as pulmonary edema,acute respiratory distress syndrome(ARDS),acute myocardial injury and malignant arrhythmia 48 hours after injury in patients of the three groups were compared.Results:data analysis showed no significant difference existed in age,burn area and weight among the three groups(P>0.05).During the shock period,the rehydration volume was higher in group C than in group A and group B,and in group B was higher than in group A(P<0.05);The incidences of pulmonary edema and ARDS were much higher in group C than in group A and group B(P<0.05),and of acute myocardial injury and malignant arrhythmia were the highest in group C and the lowest in group A with significant difference(P<0.05).As for the average urine volume per hour 48 hours after injury,no significant difference existed between group A and group B(P>0.05),but was lower in group C than in group A and group B(P<0.05).Conclusions:After routine rehydration treatment,ordinary burn patients can basically obtain satisfactory urine volume and correct shock,but some related complications still existed such as lung injury and myocardial injury.The fluid replacement volume and the incidence of pulmonary edema,ARDS,malignant arrhythmia and acute myocardial injury are higher in shock stage of burn patients with alcoholism and those patients with inhalation injury than in ordinary burn patients,and the patients in the first two groups are prone to die due to intractable shock,severe ARDS and malignant arrhythmia.Therefore,clinicians should pay special attention and give closing monitoring.Also relax the corresponding rehydration volume.