动脉灌注葡萄糖酸钙治疗手部氢氟酸灼伤的疗效和安全性  

Efficacy and safety of arterial infusion of calcium gluconate in treating hydrofluoric acid burns of hand

作　　者：张建芬[1] 吴晓霞[1] 吴军梅[1] 张元海[1] 叶春江[1] 倪良方 ZHANG Jian-fen;WU Xiao-xia;WU Jun-mei;ZHANG Yuan-hai;YE Chun-jiang;NI Liang-fang(Department of Burns and Plastic Surgery,Zhejiang Quhua Hospital,Quzhou,Zhejiang 324004,China)

机构地区：[1]浙江衢化医院烧伤整形科,浙江衢州324004

出　　处：《环境与职业医学》2018年第8期725-728,共4页Journal of Environmental and Occupational Medicine

基　　金：浙江省公益技术应用研究计划(编号:2017C33186);浙江省医药卫生平台重点项目(编号:2013ZDA025)

摘　　要：[目的]探讨动脉灌注葡萄糖酸钙治疗手部氢氟酸灼伤的疗效及安全性。[方法]2010年1月至2017年12月有47例手部氢氟酸灼伤病倒符合纳入标准。在患肢腕部桡动脉放置留置针,10%葡萄糖酸钙15 mL+10%葡萄糖35 mL微量泵20 min完成注射,对灌注后4 h创面视觉模拟评分法(VAS)疼痛评分>4.0者,行二次灌注,同时创面局部外用2.5%葡萄糖酸钙凝胶。分别在灌注前、初次灌注后即刻及4 h、二次灌注后4 h和第2天行视觉模拟量表(VAS)疼痛评分,并观察血电解质和尿氟的动态变化,以及创面愈合时间、治疗结果和不良反应。[结果]38例患者行单次灌注,灌注前和灌注后即刻、4 h和第2天的VAS疼痛评分分别为6.82±1.27、3.78±1.77、2.81±1.31和1.93±0.97,差异有统计学意义(F=93.03,P<0.01);9例行二次灌注,灌注前、初次灌注后即刻和4 h、二次灌注后4 h和第2天的VAS疼痛评分分别为7.62±1.31、4.72±0.99、4.44±0.48、3.01±0.65、2.99±0.80,差异有统计学意义(F=40.25,P<0.01)。灌注后尿氟呈下降趋势(F=10.49,P<0.01),血钙在每次灌注后均有升高(F=8.60,P<0.01)。除1例二次灌注后血钙高于参考值外,其余患者灌注后血钙均在参考值范围,未见严重不良反应。38例患者经过换药治疗创面愈合,9例创面行植皮或皮瓣修复后治愈。[结论]动脉灌注葡萄糖酸钙治疗手部氢氟酸灼伤的疗效确切,副作用轻微,是一种安全有效的治疗方法。[Objective] To evaluate the efficacy and safety of arterial infusion of calcium gluconate（CG） in the treatment of hydrofluoric acid burns of hand.[Methods] From January 2010 to December 2017,a total of 47 patients with hydrofluoric acid burns of hand met inclusion criteria.An indwelling needle was placed on the radial artery of the affected limb.They were injected with 10% CG（15 mL）＋10% glucose（35 mL） using micro pump within 20 min.For those with Visual Analogy Scale（VAS） pain score 4.0,a second infusion and topical 2.5% CG gel were given.VAS pain scores were measured before infusion,immediately after the first infusion,4 h after the first infusion,4 h after the second infusion,and the next day.Dynamic changes of blood electrolytes and urinary fluoride,wound healing time,treatment outcome,and adverse reactions were observed.[Results] Thirty-eight patients received single infusion,and the average VAS pain scores before infusion,immediately after infusion,4 h after infusion,and of the next day were 6.82±1.27,3.78±1.77,2.81±1.31,and 1.93±0.97,respectively（F=93.03,P0.01）;nine patients received two infusions,and the average VAS scores before infusion,immediately after the first infusion,4 h after the first infusion,4 h after the second infusion,and of the next day were 7.62±1.31,4.72±0.99,4.44±0.48,3.01±0.65,and 2.99±0.80,respectively（F=40.25,P0.01）.After infusion,urinary fluoride showed a trend of decline（F=10.49,P0.01）,and blood calcium increased after each infusion（F=8.60,P0.01）.Except one case whose blood calcium was higher than the reference value after the second infusion,the other patients＇ blood calcium levels were within the reference range and no severe adverse reaction was reported.Thirty-eight patients were healed after subsequent dressing treatment,and the other nine patients were healed after skin grafting or skin flap repair.[Conclusion] Arterial infusion of CG is an effective and safe treatment of hydrofluoric acid burns of hand,with few side effects.

关 键 词：化学灼伤 氢氟酸 葡萄糖酸钙 动脉灌注 疼痛评估 创面愈合 

分 类 号：R453[医药卫生—治疗学]