烧伤休克的体液复苏与胶渗压的动态改变及其临床意义  

HUMORAL RESUSCIT ATION OF THE POST-BURN SHOCK TO THE DYNAMIC CHANGDES IN COLLOID OSMOTIC PRESSURE AND THEIR CLINICAL SINNIFICANCE

作　　者：田卫[1] 刘冬梅[1] 刘军[1] 宋建忠 徐刚[1] 翟君鹤[1] 房辉[1] 冯玉柱[1] 

机构地区：[1]河北省唐山工人医院烧伤研究所

出　　处：《河北医学》1996年第2期99-103,共5页Hebei Medicine

摘　　要：将重烧伤病人随机分成两组，应用两种复苏方案进行体液复苏，对每例病人的水疱液和首次切痂痂下渗出液及不同时相的血浆进行胶体渗透压和蛋白浓度的测定，结果表明：伤后大量蛋白质尤其是白蛋白自创面丢失或进入组织间隙是伤后早期血浆胶渗压下降的根本原因，并以伤后８～１６ｈ下降到最低值；采用伤后入院加用胶体的晶胶型复苏方法并不能有效提高血浆胶渗压并造成回吸收延迟；应用伤后１２～１４ｈ开始加用胶体的改进和晶体型复苏方法更符合烧伤休克渗出特点；维持胶渗压在２．２８～２．４５ｋＰａ范围内是相对安全的．若病人胶渗压持续性低于２．００ｋＰａ是预后不良的指标；本研究提出了五条关于血浆蛋白浓度与胶渗压的直线回归方程，均可供临床选择运用，从而为临床测定胶渗压或蛋白浓度提供了一种简便可靠的检测手段。In this study the patients of grave burns were di vided into two groups at random, where two different resurgence protocols were administered respectively.In each case tests and measurements were carried out of the colloid osmotic pressure and protein concentration of phlyctena, the sub-eschar effusion collected on initial de crustation, and the Plasma in different phases of time The results of the above tests and analyses are as follows: Post-burn loss of quantities of protein, albumen in particulay, at the wounds and/or their entrance into the interstices are the main factors that should account for the post-burn decrease in plasma colloid osmotic pressure in the early stages the value reached the lowest point 8～16 hours after burn, it is revealed that the leakage peak occurs around that time;The crystalloid-colloid resurgencemodus of immediately administering colloid after hospitalization did not effectively enhanced the plasma colloid osmotic pressure, hence retarded the back absorption; the improved crystalloid resurgence modality wasbetter fit for the characteristics of exudation curing the postburn shock period For that reason the authors suggest that colloid be transfused 12～14 hours afterburn , based on the conception that this humor resurgence scheme responds better to the pathologicai changes in the post-burn shock; It is assumed that it will be rather safe to maintain the PCOP at 17.5～18.5mmHg,and that maintenance of the PCOP below 15mmHg is an index of unfavorable prognosis; this s tudy advances for clinical options 5 linearregression equations concerning the plasma protein concentration and colloid osmotic pressure. This offers a simple yet reliable clinical mcans to determine colloid osmotic pressure and protein concentration.

关 键 词：休克 复苏 胶体渗透压 蛋白浓度 烧伤 

分 类 号：R644[医药卫生—外科学]