早期心力扶持对严重烧伤患者液体复苏的效果评价  

Evaluation on effects of early cardiac supporting in fluid resuscitation of severe burn patients

作　　者：肖荣 胡东升 王国亮 袁仕安 林国安 

机构地区：[1]解放军159医院烧伤科,河南驻马店463000

出　　处：《实用医药杂志》2017年第7期606-608,共3页Practical Journal of Medicine & Pharmacy

摘　　要：目的对严重烧伤患者液体复苏过程中早期心力扶持的效果进行评估分析。方法将笔者所在中心近期收治的83例严重烧伤患者随机分为心力扶持组(42例)和对照组(41例),心力扶持组在伤后48 h内除静脉应用西地兰和乌司他丁外,其他液体复苏治疗同对照组常规。伤后48 h检测心率、血压、中心静脉压、每小时尿量等休克复苏指标,抽取静脉血检测肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、肌钙蛋白I(c Tn I)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆汁酸(TBA)、尿素氮(BUN)、肌酐(Cr)、β_2-微球蛋白(β_2-MG)等脏器损害指标。结果在达到相同复苏效果的基础上,心力扶持组所需的补液量[(2.56±0.76)ml/kg·1%TBSA]较对照组[(3.24±0.93)ml/kg·1%TBSA]明显减少,心肌损害、肝肾功能损害显著减轻,而且心力衰竭、肾衰竭、脓毒症等远期并发症减少,预后较好。结论烧伤休克期液体复苏过程中进行心力扶持,能有效减少补液量,减轻心、肝、肾等脏器损害,提高严重烧伤的救治成功率。Objective To investigate the effects of early cardiac supporting in fluid resuscitation of severe burn patients. Methods Eighty-three severe burn patients were enrolled in the study and randomly divided into cardiac supporting group （n=42） and control group （n=41）. The two groups shared a same proposal of fluid resuscitation except that the patients in cardiac supporting group were intravenously administrated Cedilanid and Ulinastatin in the resuscitation. The resuscitation effects were evaluated by heart rate,blood pressure,central venous pressure, and urine output per hour at 48 h post-burn. Serum CK-MB, LDH,cTnI,ALT,AST,TBA, BUN, Cr, 132-MG were also detected to reflect the cardiac,hepatic,and renal damages respectively. Results Compared with control group,2.56±0.76 ml/kg·1%TBSA,the volume of fluid resuscitation needed in cardiac supporting group,3.24±0.93 ml/ kg·1%TBSA,was less. And injuries to heart,liver,and kidney were mitigated in cardiac supporting group. Further more,the long-term complications such as heart failure,renal failure,and sepsis were decreased with better prognosis in cardiac supporting group. Conclusion Cardiac supporting in fluid resuscitation at early stage of severe burn can effectively decrease the volume of fluid replacement and mitigates cardiac ,hepatic ,renal damages, and improve the prognosis of severe burn patients.

关 键 词：“休克心” 西地兰 乌司他丁 缺血缺氧性损害 限制性补液 心力扶持 烧伤患者 

分 类 号：R644[医药卫生—外科学] R654.1[医药卫生—临床医学]