烧伤休克延迟快速复苏补液公式的临床研究

A Clinical Study on the Delayed Rapid Fluid Resuscitation in Burn Patients with Shock

目的 探讨烧伤休克延迟快速复苏治疗方案。方法 伤后 4～ 8h后入院的大面积烧伤病人 2 0例 ,分为血浆复苏组和4%琥珀酰明胶复苏组 ,在血流动力学监护下快速补液。监测血流动力学、血液流变学、组织氧合指标和主要脏器功能及损伤指标。结果 快速补液后 2h内输入量加院外补液量占第 1个 2 4h公式计算量的百分比为 48 3 4%,第 1个 2 4h实际输入量较公式计算量多3 1 42 %;快速补液后 ,各观测指标均获改善。结论 根据本研究结果 ,提出延迟快速复苏补液公式和方法如下 :⑴第一个 2 4h预计补液量 (m1) =TBSA( %)×体重 (kg)× 2 6+水分 2 0 0 0mL ,胶体与电解质之比为 1∶1。在血流动力学严密监护下 ,复苏的前 2h将第一个 2 4h液体总量的 1/2快速补入 ;⑵第二个 2 4h预计补液量 (m1) =TBSA ( %)×体重 (kg)× 1+水分 2 0 0 0mL ,胶体与电解质之比为 1∶1。

Objective To explore a suitable plan for the delayed rapid fluid resuscitation in burn patients with shock. Methods 20 patients with total body surface area (TBSA) burned over 40% admitted 4～8h after postburn were enrolled in this study. The patients were randomly divided into plasma and gelofusin groups. Rapid fluid replacement was given immediately after admission under close hemodynamic monitoring. Hemodynamic (PAP, PAWP, CO, PVR, SVR) and hemorrheological parameters, tissue oxygenation (DO 2, VO 2, O 2ext , lactic acid, base deficit) as well as indices reflecting the main visceral functions and damage were investigated. Results The amount of rapid fluid infusion within 2h after admission accounted for 38 8±6 1% of the amount calculated with the formula for the first 24h. When the infusion amount of pre-hospitalization was added, the amount would be (48 3±5 0)% of the amount for the first 24h. The real amount of the infusion for the first 24h was (31 4±14 3)% more than that of the amount calculated with the Evans formula. The real infused fluid amount for the second 24h was almost equal to the amount calculated with the formula. After fast fluid replacement therapy, all the parameters determined were markedly improved. Conclusions It is proposed that the formula for the delayed rapid fluid resuscitation in burn patients with shock should be: the amount infused for the first 24h (ml) =TBSA (%)×body weight (kg)×2 6,the ratio of colloid to electrolytes is 1:1, water=2000ml. Half of the total amount should be infused in the first 2h after admission under close hemodynamic monitoring. The amount infused for the second 24h (ml)=TBSA (%)×body weight (kg)×1,the ratio of colloid to electrolytes is 1:1, water=2000m1.