严重延迟复苏烧伤患者心肌损害防治的临床研究

Clinical study on prevention and treatment of myocardial damage in severely burned patients with delayed fluid resuscitation

目的 探讨减轻严重延迟复苏烧伤患者心肌损害的治疗方法。方法 将 72例延迟复苏的严重烧伤患者分为二个阶段 ,即 1990 - 0 1～ 1995 - 12 (第一阶段 ,n =2 6 )及 1996 - 0 1～ 2 0 0 1- 12 (第二阶段 ,n =4 6 ) ,进行比较分析。结果 第二阶段各时相点血清肌酸激酶同工酶 (CK -MB)、丙二醛 (MDA)均明显低于第一阶段 (P <0 0 1～ 0 0 5 )。在整个治疗过程中 ,心电图检查出现ST -T段改变第一阶段共有 7例 (2 6 9% ) ,而第二阶段仅 1例 (2 2 % ) ,P <0 0 1。结论 早期、快速、充分、有效的液体复苏、早期削 (切 )痂、早期肠道喂养、抗氧化疗法、促进心肌细胞修复药物的应用等均有助于损伤心肌的恢复。

Objective To study the prevention and treatment of myocardial damage on severely burned patients with delayed fluid resuscitation.Methods From January 1990 to December 2001,72 cases with delayed fluid resuscitation were admitted to our department,and were divided into two periods (1990-01～1995-12,1996-01～2001-12).Lactate dehydrogenase(LDH),creatine kinase isoenzyme (CK-MB)and malondialdehyde(MDA)in plasma were tested in the patients of two grorps immediately after hospitalization and postburn days (PBD)1,2,5,10,14.Electro-cardhogram (RCG) were employed to monitor cardiac function in the patients of two groups immediately after hospitalization and postburn days 1,2,5,10,14.Results ① The rate of abnormal findings of ST-T wave with ECG on the second period was lower than that on the first period( P <0.01).②The serum levels of LDH,CK-MB and MDA at almost time points on the second period were evidently lower than those on the first period( P <0.01～0.05).Conclusion Our data demonstrate that measures taken on the second period for patients with delayed fluid resuscitation,including early excision,early rapid adequate resuscitation,early enteral feeding,xenotransfusion of ultraviolet-irradiated bood(XUIL),play an important role in fluid resuscitation.