限制性液体管理策略对严重烧伤患者早期肺功能影响的对比研究  

Comparative study on the effect of restrictive fluid management strategy on the early pulmonary function of patients with severe burn

作　　者：张家平[1] 向飞[1] 童大力[1] 罗奇志[1] 袁志强[1] 颜洪[1] 李晓鲁[1] 陈建[1] 彭代智[1] 罗高兴[1] 彭毅志[1] 黄跃生[1] 吴军[1] 

机构地区：[1]第三军医大学西南医院全军烧伤研究所,创伤、烧伤与复合伤国家重点实验室,重庆 400038

出　　处：《中华烧伤杂志》2012年第3期165-169,共5页Chinese Journal of Burns

基　　金：国家自然科学基金面上项目（81171810）;全军医学科学技术研究“十二五”计划专项课题（BWS11J039）

摘　　要：目的回顾性分析限制性液体管理策略（RFMS）对特蓖度大面积烧伤患者早期肺功能及其预后的影响、方法将笔并单位2010年6月-2011年11月收治的于体液回吸收期采月]RFMS治疗的I3例特重度烧伤患者没为治疗绀，另将2008年3月-2011年11月收治的于体液回吸收期采用常规液体治疗的26例特重度烧伤患者设为对照组，2组按1：2比例配对。记录并比较2组患者伤后3-10d液体总入量、总出量与人出量差值，以及仇浆白蛋白水平；伤后3、5、7、10、14d肺氯合指数；伤后7-14d怖部和血液感染情况；伤后2周内急性呼吸窘迫综合征（ARDS）发生情况、其他脏器并发症发生情况和死亡情况：对计量资料行t检验和随机区组方差分析，计数资料行Fisher确切慨率法榆验。结果2组患者液体总入量伤后3-10d呈下降趋势。除伤后4d外，其余时相点2组液体总人量比较差异均无统计学意义（F值为0．072-1．939，P值均大于0．05）。2组患者液体总出量伤后3-10d晕上升趋势，对照组于伤后10d达峰值．治疗组于伤后6d达峰值。伤后4-9d，治疗组液体总出量大于对照组（F值为0．001-3．026，P值均大于0．05）：2组患者液体入出量差值呈下降趋势，对照组于伤后10d达低谷．治疗组于伤后6d达低谷。伤后3-7d治疗组液体入出最差值低于对照组，其中伤后4-6d组问比较差异有统计学意义（F值为4．799-8．031，P值均小于0．05）？伤后3-10d治疗组血浆白蛋白水平均高于对照组，其中伤后4、9、10d组问比较羞异有统计学意义（F值为5．691-10．551，P〈0．05或P〈0．01）。伤后3-14d治疗组肺氧合指数均高于对照组．其中伤后7、14d治疗组（分别为372±78、354±39）明湿高于对照组（分别为291±92、283±72．F值分别为5．184、8．683，P值均小于0．05）。伤后7-14d治疗组患者巾发生肺部和血液感染者分别为1、4例，少于对照组的9、1Objective To retrospectively analyze the effect of restrictive fuid management strategy （RFMS） on the early pulmonary function and the prognosis of patients with extremely severe and extensive burn. Methods Thirteen patients with extremely severe burn hospitalized from June 2010 to November 2011 , being treated with RFMS in the fluid reabsorption stage, were enrolled as treatment group. Twenty-six patients with extremely severe burn hospitalized from Marcia 2008 to November 2011 , being treated with nor- real fluid therapy in the fluid reabsorplion stage, were enrolled as control group. The match proportion be- tween treatment group and control group was 1：2. Fluid intake, fluid output, fluid baIance （the difference between fluid intake and oulput） , and plasma albumin level from post burn day （PBD） 3 to 10, pulmonary oxygenation index on PBD 3, 5, 7, IO, and 14, occurrence of lung and blood stream infcctions from PBD 7to 14, and occurrence of acute respiratory distress syndrome （ARDS） , occurrence of other organ complica- tions, and mortality within 2 weeks post burn （PBW） were recorded and compared. Measurement data were processed with t test and randomized blocks analysis of variance, enumeration data were processed with Fish- er＇s exact test. Results Daily fluid intake of patients showed a tendency of decrease in both groups from PBD 3 to 10. Except for that of PBD 4, there was no statistically significant difference between two groups in fluid intake （ with F values from 0. 072 to 1. 939, P values all above 0.05 ）. Daily fluid output of patients showed a tendency of increase in both groups from PBD 3 to 10. It peaked on PBD 10 in control group and PBD 6 in treatment group. The mean daily fluid output was higher in treatment group than in control group from PBD 4 to 9, but without statistically significant difference （ with F values from 0. 001 to 3. 026, P values all above 0.05）. Fluid balance lowered in both groups, and it was the lowest on PBD 10 in control group and PBD 6 i

关 键 词：烧伤 水电解质平衡 肺水肿 肺氧合功能 限制性液体管理策略 

分 类 号：R644[医药卫生—外科学]