高原地区严重烧伤休克期补液公式探讨  

Resuscitation of Severe Burns at High Altitude:A Study of Fluid Prescribing Practice in Burn Shock

作　　者：汪家莹[1] 张西联[1] 孙胜[1] 史连胜[1] 王秀亮[1] 李浩[1] 

机构地区：[1]解放军第22医院,格尔木816000

出　　处：《青海医药杂志》2010年第9期6-9,共4页Qinghai Medical Journal

摘　　要：目的:探讨高原地区成人严重烧伤休克期复苏补液量的参考公式,指导临床治疗。方法:将笔者单位自2004年—2010年收治的45例严重烧伤成人患者按完全随机法分为按第三军医大学公式补液组(三医大公式组)及高原补液组(高原组)。两组患者入院后均以常规抗休克补液,按三医大公式组即按照第三军医大学公式补液,高原组即在按三医大公式组的基础上等比例增加晶胶体补液量,并根据中心静脉压的变化做调整。两组均于补液前、补液后2h、6h及12h、伤后24h及48h 6个时相点,监测患者的尿量、心率、血压指标,并采集股静脉血检测主要脏器功能及损伤指标。结果:高原组较按三医大公式组复苏补液量多,差异非常显著(P<0.01),两组尿量、心率、脉压差及主要脏器功能及损伤指标也有显著差异(P<0.05),高原组主要脏器损伤轻。结论:根据本临床研究结果,提出高原地区成人严重烧伤休克期复苏补液的参考公式如下:①第一个24h预计补液量(mL)=TBSA(%)×体重(kg)×2.9mL+水分2 500mL,晶体与胶体之比为2.2:1;②第二个24h预计补液量(mL)=TBSA(%)×体重(kg)×1.6mL+水分2 500mL,晶体与胶体之比为2:1。Objective：To research fluid resuscitation of severe burns in shock stage in adults at high altitude.Methods：20 adult patients with server burns（aged 17 to 62 years） admitted in our hospital from 2004 to 2008 were randomLy divided into 2 groups： the group A（n=10） that were treated by fluid prescribing practice（rehydrating formula） designed by Third Military Medical University（TMMU） only,and the group B（high altitude group,n=10） that were transfused more electrolytes and colloid fluid on basis of rehydrating formula of TMMU for fluid resuscitation,and the fluid volume was regulated with the changes of center venous pressure.After 24 and 48 hours burns,the urinal volume,heart rate and blood pressure were measured before and after 2,6 and 12 hours resuscitation in the two phases,as well as measurement of liver function,kidney function and myocardial enzymes in the two groups.Results：There was slighter injury in organ function in the group B as compared with group A,and the transfused volume was more increase in the group B than that in group A（P0.01）.And the differences in the urinary volume,heart rate and pulse pressure between the two groups were significant（P0.05） at 2,6 and 12 hours.Conclusions：Our results suggest that the rehydrating formula of resuscitation for adult patients with severe burns associated with shock at high altitude is as following： TBSA（%）×body weight（kg） ×2.9 plus water 2 500mL for the planning predicting volume（mL） of transfusion in the first 24 hours,and electrolytes versus colloid in a ratio of 2.2：1;in the second 24 hours,the planning volume formula is as TBSA（%）×body weight（kg） ×1.6 plus water 2 500mL,the electrolytes versus colloid in a ratio of 2：1.

关 键 词：严重烧伤 高原地区 休克期 补液公式 

分 类 号：R644[医药卫生—外科学]