心力扶持对大面积烧伤患者休克延迟复苏的影响  

Effects of cardiac support on delayed resuscitation in extensively burned patients with shock

作　　者：肖荣 黄跃生 林国安 袁仕安 胡东升 

机构地区：[1]解放军第一五九医院全军烧伤中心,河南省驻马店市463008 [2]陆军军医大学(第三军医大学)第一附属医院全军烧伤研究所,创伤、烧伤与复合伤国家重点实验室

出　　处：《中华烧伤杂志》2018年第1期8-13,共6页Chinese Journal of Burns

摘　　要：目的探讨心力扶持对大面积烧伤患者休克延迟复苏的影响。方法回顾性分析解放军第一五九医院（以下称笔者单位）2012年1月-2017年1月收治的入院时伴有休克的62例大面积烧伤患者的病历资料，按液体复苏过程中是否应用去乙酰毛花苷和乌司他丁分为心力扶持组（35例）和对照组（27例）。2组患者入院后均以第三军医大学补液公式为基础行常规液体复苏至伤后48h。心力扶持组患者另将去乙酰毛花苷注射液以首次剂量0．4～0．6mg加入20mL的100g／L葡萄糖注射液中缓慢静脉推注，每6～8小时补充0．2～0．4mg，每日总量不超过1．6mg；将注射用乌司他丁1×10^5U加入到100mL的50g／L葡萄糖注射液中缓慢静脉滴注，每12小时1次。2组患者其他治疗方法均按笔者单位常规方案执行。统计2组患者如下指标。（1）伤后48h内的每小时尿量和伤后48h的心率、平均动脉压（MAP）、中心静脉压（CVP）、血乳酸、剩余碱、血细胞比容（HCT）和血白蛋白。（2）伤后第1、2个24h电解质、胶体输入量以及伤后48h内总补液量。（3）伤后48h的肌酸激酶（CK）、心肌型肌酸激酶同工酶（CK—MB）、乳酸脱氢酶（LDH）、总胆汁酸（TBA）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、β2微球蛋白（β2-MG）、尿素氮、肌酐。（4）患者心力衰竭、肺水肿、胸腔积液、腹腔积液、肾功能衰竭、脓毒症及死亡情况。对数据行独立样本t检验、Fisher确切概率法检验、Pearsonχ^2检验、连续校正z。检验。结果（1）2组患者伤后48h内的尿量和伤后48h的心率、MAP、CVP、HCT、血白蛋白等指标差异无统计学意义（t=0．150、0．488、0．805、0．562、1．742、0．696，P〉0．05）；心力扶持组患者血乳酸和剩余碱水平分别为（4．2±2．2）、（ 4．3±2．0）mmol／L，明显优于对照组的（5．9±1．7）、（ 6．0±3．1）mmol／L�Objective To explore the effects of cardiac support on delayed resuscitation in extensively burned patients with shock. Methods Clinical data of 62 extensively burned patients with shock on admission, admitted to the 159th Hospital of PLA （ hereinafter referred to as our hospital） from January 2012 to January 2017, were retrospectively analyzed. They were divided into cardiac support group （ n=35） and control group （ n = 27） according to the use of deslanoside and ulinastatin. All patients were treated with routine fluid resuscitation based on the formula of the Third Military Medical University till post injury hour （PIH） 48. Patients in cardiac support group were given slow intravenous injection of deslanoside which was added in 20 mL 100 g/L glucose injection with first dose of 0.4 to 0.6 rag, 0.2 to 0.4 mg per 6 to 8 h, no more than 1.6 mg daily, and slow intravenous injection of 1 × 10^5 U ulinastatin which was added in 100 mL 50 g/L glucose injection, once per 12 h. Other treatments of patients in the two groups followed the same conventional procedures of our hospital. The following data of the two groups of patients were collected. （ 1 ） The data of urine volume per hour within PIH 48, heart rate, mean arterial pressure （MAP） , central venous pressure （CVP）, blood lactic acid, base excess, hematocrit, and albumin at PIH 48 were recorded. （2） The input volumes of electrolyte, colloid within the first and second 24 hours post burn and the total fluid in- put volumes within PIH 48 were recorded. （3） The data of creatine kinase, ereatine kinase isoenzyme-MB, lactate dehydrogenase, total bile acid, alanine aminotransferase, aspartate aminotransferase, 132-microglobulin, urea nitrogen, and creatinine at PIH 48 were recorded. （4） The complications including cardiac failure, pulmonary edema, pleural effusion, seroperitoneum, renal failure, sepsis, and death were also recorded. Data were processed with independent sample t test, Fisher＇s exact test, Pearson chi-square tes

关 键 词：烧伤 休克 补液疗法 延迟复苏 心肌损害 去乙酰毛花苷 乌司他丁 

分 类 号：R644[医药卫生—外科学]