严重烧伤或伴吸入性损伤患者抗休克复苏补液问题的探讨  

Discussion of liquid resuscitation during shock period in patients with severe burns or burns complicated by inhalation injury

作　　者：徐朝晖[1] 徐国士[2] 张艳敏[1] 朱静[1] 董贝[1] 

机构地区：[1]安徽省淮北市人民医院烧伤科,235000 [2]青岛市市立医院烧伤科,266011

出　　处：《中华损伤与修复杂志（电子版）》2013年第3期19-22,334,共4页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的探讨严重烧伤或伴吸入性损伤患者抗休克复苏补液问题。方法收集在2002年至2009年收治的严重烧伤或伴吸入性损伤患者63例的临床资料,其中男性46例,女性17例,年龄15～73(35.08±13.23)岁,烧伤总面积50%～100%(71.56±15.19)%,Ⅲ度烧伤面积0～98%(23.05±25.47)%,单纯烧伤患者52例,烧伤合并吸入性损伤患者11例。依据患者是否合并吸入性损伤分为单纯烧伤组与吸入性损伤组。统计烧伤后第1个24h前8h、后16h以及第2个24h的呼吸、心率、尿量、血氧饱和度(SaO2)及晶体、胶体和水分补液量。使用SPSS17.0统计软件对两组不同时段统计指标进行比较。结果烧伤后的第1个24h前8h、后16h及第2个24h内,单纯烧伤组与吸入性损伤组的补液量差异无统计学意义(P均>0.05);吸入性损伤组心率高于单纯烧伤组11～17次/min,差异有统计学意义(t=-2.40、-3.31、-2.10,P均﹤0.05)。结论单纯烧伤与合并吸入性损伤患者抗休克复苏补液量并无不同,对于合并吸入性损伤的患者,抗休克复苏不应刻意提高补液量;对于合并吸入性损伤的严重烧伤患者,抗休克复苏时心率的监测标准是否可以适当提高值得商榷。Objective To discuss the problem of liquid resuscitation during shock period in patients with severe burns or burns complicated by inhalation injury. Methods The clinical datum of 63 patients who were severe burned were collected between 2002 and 2009. There were 46 males and 17 females, the ages ranged from 15 to 73 （35.08 ± 13.23） years old, the burned areas from 50% to 100% （71.56 ± 15.19） %, and third degree burned area from 0 to 98% （23.05 ± 25.47） %. Fifty-two patients were pure burned and eleven patients were burned complicated by inhalation injury. All the patients were divided into two groups according to whether complicated by inhalation injury. The respiratory rate, heart rate, urine volume, oxygen saturation of blood and the capacity of crystal, colloid, moisture were counted in the first 8 hours, the next 16 hours and the second 24 hours after burned. The urine volume of each hour of each kilogram and the capacity of crystal and colloid of each burned area of each kilogram were calculated. All the statistical indexes of the two groups were compared through statistical software SPSS 17.0. Results In the first 8 hours, the next 16 hours and the second 24 hours after burned, there were no differences in the amount of fluid between the burns group and the inhalation injury group （ each P 〉 0.05 ）, and the heart rate of the inhalation injury group was higher than the burns group, there was statistical significance （t = - 2. 40, - 3.31, - 2. 10, each P 〈 0.05）. Conclusions There is no difference in the amount of fluid during shock stage between burns and burns with inhalation injury. Whether to enhance the monitoring standard of heart rate should be deserved discussion.

关 键 词：严重烧伤 吸入性损伤 休克期 液体复苏 

分 类 号：R644[医药卫生—外科学]