严重烧伤休克期不同补液剂量对小儿心肺肾功能的影响  

On functions of heart, pulmonary, renal in the children with extensive burns in effects of fluid resuscitation during shock stage

作　　者：周锐华[1] 鄢文海[2] 张巨祥[1] 韩俊杰[1] 王兵[1] 张秀丽[1] 

机构地区：[1]濮阳市油田总医院烧伤整形科,457001 [2]郑州大学基础医学院病理生理教研室,450052

出　　处：《中华损伤与修复杂志（电子版）》2012年第4期28-32,共5页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的探讨休克期补液对小儿烧伤B型尿钠肽、胱抑素-C、肺泡-动脉氧分压差的影响。方法对120例小儿严重烧伤进行补液治疗,其中重度烧伤60例,特重度烧伤40例,延迟复苏20例。有休克症状的经液体复苏达休克治疗终点指标。烧伤早期1、3、5d进行B型尿钠肽、胱抑素-C、肺泡-动脉氧分压差检测,同时依据美国纽约心脏病学会心衰分级标准及多器官功能障碍综合征诊断评分标准评估,所获数据样本均数比较采用u检验,心、肾、肺器官功能障碍进行直线相关分析。结果补液治疗第1个24h实际补液总量占公式计算量无休克患儿67例(108.5±7.3)%,休克患儿53例(142.8±30.2)%。第2个24h实际补液总量占公式计算量96例(104.6±10.7)%,平稳度过休克期;21例在6h内达休克治疗终点指标的(120.0±9.4)%,休克期度过不平稳。第1个24h补液总量共有36例(30%)达个体血容量的3倍,其中7例(5.8%)超过个体血容量的4倍。B型尿钠肽、胱抑素-C、肺泡-动脉氧分压差值随烧伤严重程度、延迟复苏同时相点呈上升趋势。第3天发生心功能障碍28例,肾功能障碍33例,肺功能障碍21例。心功能与肾、肺功能呈正相关(r=0.486,r=0.473),肾功能与肺功能无相关性(r=0.358)。结论小儿严重烧伤后给予及时、快速、充分的液体治疗,尽快纠正休克,动态监测评估心、肾、肺功能,实施个体化综合治疗。特重烧伤第1个24h补液总量以不超过个体血容量的3倍是安全的。Objective To investigate the effects of fluid resuscitation for shock on B type natriuretic peptide, cystatin C, alveolar arterial oxygen partial pressure difference in children with extensive burns. Methods In 120 Children with burns fluid therapy was performed, severe burn in 60 cases, extensive burn in 40 cases, delayed resuscitation in 20 cases. Those with shock symptoms got shock treatment endpoints after fluid resuscitation. B type natriuretic peptide, cystatin C, alveolar arterial oxygen partial pressure difference were detected as early as 1, 3, 5 days, at the same time the patients were assessed on the basis of the heart failure classification standard and multiple organ dysfunction syndrome diagnostic criteria by New York Society of Cardiology of United States. The obtained data were analyzed by sample u test. In heart, renal, pulmonary organ dysfunction, linear correlation analysis was done. Results Fluid therapy in the first 24 h to total fluid volume was （108.5±7.3）% in 67 cases in no-shock group, （142.8±30.2）% in 53 cases in shock group. In the second 24 h actual fluid to total formula calculation was （104.6±10.7）% in 96 cases, smooth through the burn shock stage; 21 cases in 6 h were （120.0±9.4）% of shock treatment endpoints, not stable through shock stage. In the first 24 h fluid volume in 36 cases （30%） was 3 times the individual blood volume, including 7 cases （5.8%） 4 times the individual blood capacity. B type natriuretic peptide, cystatin C, alveolar arterial oxygen partial pressure difference increased with delayed resuscitation of burn severity at the same time points. At the third day the heart dysfunction was found in 28 cases, renal dysfunction in 33 cases, pulmonary dysfunction in 21 cases. Heart function and renal, pulmonary function （r=0.486, r=0.473） were positively correlated, renal and pulmonary function （r=0.358） showed no correlation. Conclusions Children with severe burns need timely, rapid, adequate fluid therapy, treatment of shock, dynamic

关 键 词：烧伤 儿童 休克 补液疗法 B型尿钠肽 胱抑素-C 血气分析 

分 类 号：R726.5[医药卫生—儿科]