严重烧伤或伴吸入性损伤患者休克期输液问题及死亡原因探讨

Fluid management and cause of death during shock period in patients with severe burns or burns complicated by inhalation injury

的 探讨严重烧伤或伴吸入性损伤患者休克期输液问题以及死亡原因。 方法在 1991～ 2 0 0 0年间收治的严重烧伤或伴吸入性损伤患者 112例 ,对这些患者休克期的诊断、输液情况、死亡情况进行了总结。 结果 休克期的输液情况可归纳为 :第 1个 2 4h总入量 2 2ml/ (%TBSA·kg) ,其中胶体 0 5ml/ (%TBSA·kg) ,晶体 1ml/ (%TBSA·kg) ,其余为水分。第 2个 2 4h总入量 1 8ml/(%TBSA·kg) ,其中胶体 0 4ml/ (%TBSA·kg) ,其余为晶体、水分各半。单纯烧伤与烧伤伴吸入性损伤的输液情况 ,两者并无差异。休克期 7例患者死亡 ,原因均为呼吸衰竭 ,其中 3例休克未能纠正。 结论 各种输液公式均可为休克期补液提供参考 ,最重要的是应根据病人具体情况进行输液 ,以保证病人平稳渡过休克为最终目的。单纯烧伤和烧伤伴吸入性损伤患者休克期输液量并无不同。

Objective To explore fluid management and cause of death during shock period in severe burns or burns with inhalation injury. Methods One hundred and twelve patients with severe burns or burn complicated by inhalation injury admitted to our hospital from 1991 to 2000 were analyzed. The fluid management and death conditions during shock period were discussed. Results The fluid volume for resuscitation could be described as follows: the total fluid volume was 2.2 ml/(%TBSA·kg) including colloid fluid 0.5 ml /(%TBSA·kg), crystalloid fluid 1 ml/(%TBSA·kg)and water 0.7 ml/(%TBSA·kg) during first 24 hours. The total fluid volume was 1.8 ml/(%TBSA·kg) including colloid fluid 0.4 ml/(%TBSA·kg), crystalloid fluid 0.7 ml/(%TBSA·kg) and water 0.7 ml/(%TBSA·kg) during second 24 hours. There were no difference in fluid management between burns and burns with inhalation injury. Seven patients died due to respiratory failure during shock period. Conclusions Many fluid formula can provide guidance for resuscitation and it is very important that early fluid therapy should accord with concrete clinical conditions of patients in order to pass smoothly through shock period. Early fluid management is not different between burns and burns with inhalation injury.