大面积烧伤休克期切痂植皮  

Escharectomy during burn shock stage in extensively burned

作　　者：郭振荣[1] 盛志勇[1] 刁力[1] 高维谊[1] 杨红明[1] 林洪远[2] 韩家林 

机构地区：[1]北京中国人民解放军第三○四医院烧伤科,100037 [2]北京中国人民解放军第三○四医院ICU室,100037

出　　处：《中华整形烧伤外科杂志》1993年第1期5-8,77,共4页

摘　　要：为缩短疗程,减少坏死组织对机体的中毒反应,开展了休克期内切痂植皮手术。病人21例,烧伤面积63.2±18.1%,Ⅲ度36.9±19.6%,开始手术时间24.1±13.9h,一次切痂面积32.3±7.1%。利用Swan-Ganz导管监测了术前、术中及术后的RAP、PAP、PAWP、ABP、HR、CO及CI,结果都很平稳。与条件相似的29例非休克期切痂病人对比表明:休克期切痂病人愈合天数缩短10天左右,血浓缩缓解快,二周内输血量减少700ml左右,Hb及Hct均维持在正常水平。应用抗生素的种类及时间减少,内脏并发症也较少。In order to stop excessive plasma loss, to alleviate noxious effects of devitalized tis-sues on the body, and to shorten the hospitalization time, we have attempted to performextensive escharectomy during the shock period in extensively burned patients.Group 1 consisted of 17 patients, aged 19 to 45 years. with mean total burn area58±15.9% TBSA, and full-thickness injury involving 32.0±17.2% TBSA. The first esch-arectomy was done at 26.2±14.6 h postburn, and excision area averaged 32.0±7.1%(24% to 46%). In 13 of them, Swan-Ganz caethter was introduced to monitor the hemo-dynamic changes. It was found that RAP, PAP, PAWP, ABP, HR, CO and CI were allstable during and after the operation. Group 2 consisted of 29 patients, in whom eschar-ectomy was begun 4～5 days postburn. The mean healing time of the patients in group 1was 31.7 days, which was shorter than that of group 2 (40.1 days). The duration ofhemoconcentration was shorter in group 1. The amount of blood transfusion was almost1000ml less in group 1 during the first two weeks. Less antibiotics were used with fewervisceral complications in group 1. The authors believe that escharectomy during the burshock stage is feasible.

关 键 词：烧伤 休克 切痂植皮 

分 类 号：R644[医药卫生—外科学]