重度烧伤患者早期液体复苏与血钠变化观察  

Observation on the fluid resuscitation and the change in blood sodium of severely burned patients in the early stage

作　　者：张洪辉[1] 李跃军[1] 李学拥[1] 陈绍宗[1] 吕小星[1] 冯剑[1] 李靖[1] 蒋立[1] 

机构地区：[1]第四军医大学唐都医院整形烧伤科,西安710038

出　　处：《中华烧伤杂志》2010年第5期371-373,共3页Chinese Journal of Burns

摘　　要：目的 了解重度烧伤患者早期电解质与胶体混合液体复苏量、电解质与胶体比值及血钠的改变. 方法 选择2004年3月-2009年3月笔者单位收治的烧伤总面积大于或等于70%,且Ⅲ度面积大于或等于50%TBSA的67例行液体复苏患者.回顾性总结患者伤后24、48、72 h电解质、胶体和水分的输入量及尿量,同时记录患者不同时间段血钠变化与补液情况.数据用SPSS 13.0软件行统计学分析. 结果 67例患者中,9例早期出现低钠血症、5例出现高钠血症、53例血钠正常.患者伤后72 h内尿量均在70 mL/h以上.患者实际补充的电解质和胶体总量（mL）=烧伤总面积（%TBSA）×体质量（kg）×K,上述公式中的K值在伤后第1个24 h约为1.7,电解质与胶体比值约为1.4;伤后第2个24 h的K值为1.3,电解质与胶体比值为1.6;伤后第3个24 h的K值为0.9,比值为2.0. 结论 重度烧伤患者早期实际液体复苏量略大于传统公式计算量（K值为1.5）.早期液体复苏过程中电解质量以及电解质与胶体比值会影响患者血钠水平.Objective To study the necessary amount of fluid consisting of electrolyte and colloid,the ratio of electrolyte and colloid used, and the change of blood sodium during early resuscitation in severely burned patients. Methods Sixty-seven patients with total burn surface area （TBSA） equal to or over 70% and full-thickness area equal to or over 50% TBSA, hospitalized from March 2004 to March 2009, were resuscitated with fluid. The infusion amount of electrolyte, colloid, and water, and urinary output of patients at post injury hour （ PIH ） 24, 48, and 72 were analyzed retrospectively. The variation in blood sodium and fluid infusion at different time points was recorded. Data were processed with SPSS 13.0 software. Results Among the 67 patients, hyponatremia occurred in 9 cases, hypernatremia occurred in 5 cases, and 53 patients had normal blood sodium level. The urinary output of patients within PIH 72 was above 70 mL/h. K value was calculated through the formula： actual total infusion amount of electrolyte and colloid （mL） = burn area （ % TBSA） × body weight （kg） × K. In the first 24 PIH, K value was about 1.7, and the ratio of electrolyte and colloid was 1.4. In the second 24 PIH, K value was about 1.3 with electrolyte and colloid ratio 1.6. K value in the third 24 PIH was about 0.9 with electrolyte and colloid ratio 2.0. Conclusions The actual amount of resuscitation fluid is slightly larger than that calculated from traditional formula during the early stage in severely burned patients. The amount of electrolytes and the proportion of electrolyte and colloid will influence blood sodium level of patients.

关 键 词：重度烧伤 液体复苏 血钠 

分 类 号：R686[医药卫生—骨科学]