特重度烧伤患者切痂植皮术中控制性降压的适宜程度  

Optimum degree of controlled hypotension during eschar excision and skin grafting in patients with extremely severe burn

作　　者：王车江[1] 田长征[2] 冯建科[1] 魏伟[1] 郑德利[2] 白永强[1] 周长浩[2] 张庆富[1] 

机构地区：[1]河北医科大学第一医院烧伤科,石家庄市050031 [2]河北医科大学第一医院麻醉科,石家庄市050031

出　　处：《中华麻醉学杂志》2014年第5期597-600,共4页Chinese Journal of Anesthesiology

摘　　要：目的 探讨特重度烧伤患者切痂植皮术中控制性降压的适宜程度.方法 拟行切痂植皮术的特重度烧伤患者30例,年龄18 ～ 54岁,性别不限,体重56 ～ 75 kg,ASA分级Ⅲ或Ⅳ级,烧伤总面积70％ ～ 95％,Ⅲ度烧伤面积50％ ～ 75％,术中切痂面积28％ ～ 33％,采用随机数字表法,将患者分为3组（n=10）：对照组（C组）和不同程度控制性降压组（CH1,2组）.C组不行控制性降压,维持MAP 80 ～ 90 mmHg; CH1,2组静脉输注硝酸甘油0.2～ 0.8 μg·kg-1·min-进行控制性降压,CH1组MAP降低幅度为基础值的10％,CH2组MAP降低幅度为基础值的20％.于术前30 min（T1）和术毕（T2）时测定血清肌酐（Cr）、尿素氮（BUN）浓度,尿β2-微球蛋白（β2-MG）和尿微量白蛋白（mALB）浓度.记录术中失血量及尿量.术后24h内记录急性肾损伤的发生情况及程度.结果 与C组比较,CH1组和CH2组术中失血量减少,CH2组尿量减少,T2时血清Cr浓度、尿β2-MG和mALB浓度升高（P＜0.05）,CH1组肾功能各指标差异无统计学意义（P＞0.05）;与CH1组比较,CH2组T2时血清Cr浓度、尿β2-MG和mALB浓度升高（P＜0.05）,术中失血量、尿量差异无统计学意义（P＞0.05）.C组和CH1组术后未见急性肾损伤发生,CH2组急性肾损伤发生率为40％,均为Ⅰ期.结论 MAP降低幅度为基础值的10％是特重度烧伤患者切痂植皮术中控制性降压的适宜程度.Objective To investigate the optimum degree of controlled hypotension during eschar excision and skin grafting in the patients with extremely severe bum.Methods Thirty patients with extremely severe burn,aged 18-54 yr,weighing 56-75 kg,of ASA physical status Ⅲ or Ⅳ,with total burn covering 70%-95% of total body surface area,a third-degree burn covering 50%-75% of total body surface area,and excision covering 28%-33% of total body surface area,scheduled for elective eschar excision and skin grafting,were randomly divided into3 groups （n =10 each） using a random number table：control group （group C） and different degrees of controlled hypotension groups （CH1.2 groups）.In group C,controlled hypotension was not performed,and mean arterial pressure （MAP） was maintained at 80-90 mmHg.Controlled hypotension was induced with continuous iv infusion of nitroglycerin at a rate of 0.2-0.8 μg· kg-1· min-1.MAP decreased by 10% of baseline value in group CH1 and by 20% of baseline value in group CH2.At 30 min before surgery and the end of surgery,serum creatinine （Cr）,blood urea nitrogen （BUN）,urinary β2-microglobulin （β2-MG） and microalbumin （mALB） concentrations were detected.The volume of blood loss and urine volume were recorded during surgery.Acute renal injury was recorded within 24 after surgery and graded.Results Compared with group C,the volume of blood loss during surgery was significantly reduced in CH1 and CH2 groups,urine volume was reduced,and serum Cr,urinary β2-MG and mALB concentrations were increased at T2 in CH2 group,and no significant change was found in each parameter of renal function in group CH1.Compared with group CH1,the serum Cr,urinary β2-MG and mALB concentrations were increased at T2,and no significant change was found in the volume of blood loss and urine volume during surgery in CH2 group.No patients developed acute renal injury after surgery in C and CH1 groups,and the incidence of acute renal injury was 40% and all were in stage Ⅰ in CH2 group.Conc

关 键 词：烧伤 降压 控制性 皮肤移植 

分 类 号：R644[医药卫生—外科学]