限制性液体管理策略在预防严重烧伤早期肺脏并发症中的价值  

Value of restrictive fluid management strategy in the prevention of early pulmonary complications during early stage after severe burn

作　　者：林凤娟 姚宋珍 LIN Feng-juan;YAO Song-zhen(Department of Burn Plastic Surgery,YunFu People′s Hospital,Guangdong Province,Yunfu,527300,China)

机构地区：[1]广东省云浮市人民医院烧伤整形科

出　　处：《中国当代医药》2019年第27期79-81,85,共4页China Modern Medicine

摘　　要：目的评价限制性液体管理策略在预防严重烧伤早期肺脏并发症中的应用价值。方法选取2015年1月~2019年1月我院烧伤科收治的60例严重烧伤患者作为研究对象,采用随机数字表法分为对照组和观察组,每组各30例,分别采用常规液体管理和限制性液体管理。记录并比较两组患者烧伤回吸收期不同时间血管外肺水指数(EVLWI)、肺血管通透指数(PVPI)、氧合指数(PaO2/FiO2)等肺部情况以及患者的并发症发生率。结果休克末期,两组患者的EVLWI比较,差异无统计学意义(P>0.05);观察组患者治疗后各时间点的EVLWI均低于对照组,差异有统计学意义(P<0.05);休克末期及治疗后各时间点,两组患者的PVPI比较,差异无统计学意义(P>0.05);两组患者休克末期的PaO2/FiO2比较,差异无统计学意义(P>0.05);观察组患者治疗后各时间点的PaO2/FiO2均高于对照组,差异有统计学意义(P<0.05);治疗期间,观察组患者的呼吸机使用率、肺部感染发生率、急性呼吸窘迫综合征(ARDS)发生率均低于对照组,差异有统计学意义(P<0.05)。结论在严重烧伤早期采用限制性液体管理,可以显著改善患者的EVLWI和PaO2/FiO2,减少不良反应的发生,在预防肺脏并发症中具有重要的作用。Objective To evaluate the value of restrictive fluid management in the prevention of early pulmonary complications after severe burns.Methods A total of 60 cases of patients with severe burns admitted to the burn department of our hospital from January 2015 to January 2019 were selected as the subjects,and divided into control group and observation group,with 30 cases in each group,they were treated with conventional liquid management and restricted liquid management respectively.The extra vascular lung water index(EVLWI),pulmonary vascular permeability index(PVPI)and oxygenation index(PaO2/FiO2)at different time of burn recovery period and the incidence of complications were recorded and compared.Results At the end of shock,there was no significant difference in ELWI between the two groups(P>0.05).After treatment,EVLWI of the observation group at each time point were significantly lower than those in the control group(P<0.05).There were no significant differences in PVPI between the two groups at the end of shock and at each time point after treatment(P>0.05).At the end of shock,there was no significant difference in PaO2/FiO2 between the two groups(P>0.05).After treatment,PaO2/FiO2 of the observation group at each time point was significantly higher than that in the control group(P<0.05).During the treatment,the ventilator utilization rate,lung infection rate and acute respiratory distress syndrome(ARDS)rate in the observation group were significantly lower than those in the control group(P<0.05).Conclusion Restrictive fluid management in the early stage of severe burns can significantly improve EVLWI and PaO2/FiO2,reduce adverse reactions,and play an important role in the prevention of pulmonary complications.

关 键 词：限制性液体管理 严重烧伤 血管外肺水指数 肺血管通透指数 氧合指数 

分 类 号：R644.06[医药卫生—外科学]