不同年龄段不同烧伤面积严重烧伤患儿休克期液体复苏策略及疗效评价  

Fluid resuscitation strategy and efficacy evaluation in shock stage in severely burned children with different burn areas in different age groups

作　　者：杨萌 戴小华[1] 郭光华[1] 闵定宏[1] 廖新成[1] 张红艳[1] 付忠华[1] 刘名倬[1] Yang Meng;Dai Xiaohua;Guo Guanghua;Min Dinghong;Liao Xincheng;Zhang Hongyan;Fu Zhonghua;Liu Mingzhuo(Department of Burns,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院烧伤科,330006

出　　处：《中华烧伤杂志》2021年第10期929-936,共8页Chinese Journal of Burns

基　　金：国家自然科学基金地区科学基金项目(81760342,81960352)。

摘　　要：目的探讨不同年龄段不同烧伤面积严重烧伤患儿休克期液体复苏策略并进行疗效评价。方法采用回顾性队列研究方法。2015年1月—2020年6月,南昌大学第一附属医院收治235例符合入选标准的重度及以上烧伤患儿,其中男150例、女85例,年龄3个月~12岁。入院后计划按照国内小儿烧伤休克补液公式采用电解质、胶体及水分对患儿进行补液,根据患儿精神状态、末梢循环、心率、血压、尿量等适当调整补液量及速度。统计所有患儿补液8 h与伤后第1、2个24 h实际输入和计划输入电解质量、胶体量、水分量、液体总量。根据补液8 h尿量情况,将所有患儿分为尿量≥1 mL·kg^(-1)·h^(-1)的尿量维持满意组(119例)和尿量<1 mL·kg^(-1)·h^(-1)的尿量维持不满意组(116例),计算患儿补液8 h电解质系数、胶体系数、水分系数。根据烧伤总面积,将<3岁(155例)、3~12岁(80例)年龄段患儿均分为15%~25%体表总面积(TBSA)组和>25%TBSA组,计算或统计患儿伤后第1、2个24 h电解质系数、胶体系数、水分系数、尿量,统计患儿伤后48 h体温、心率、呼吸频率、经皮动脉血氧饱和度等无创监测指标以及血细胞比容、血小板计数、血红蛋白、白蛋白、肌酐、丙氨酸转氨酶(ALT)等疗效指标水平。统计所有患儿治疗期间并发症、治愈、好转出院、自动出院及死亡情况等预后及转归指标。对数据行独立样本或配对样本t检验、Mann-Whitney U检验、χ^(2)检验以及Fisher确切概率法检验。结果所有患儿补液8 h实际输入电解质量明显大于计划输入量,实际输入胶体量、水分量及液体总量均明显小于计划输入量(Z=13.094、5.096、13.256、7.742,P<0.01);伤后第1、2个24 h实际输入电解质量明显大于计划输入量,实际输入水分量与液体总量明显小于计划输入量(Z=13.288、-13.252、3.867,13.183、-13.191、10.091,P<0.01),实际输入胶体量与计划输入量相近Objective To explore the fluid resuscitation strategy in shock stage in severely burned children with different burn areas in different age groups,and to evaluate the curative effect.Methods A retrospective cohort study was conducted.From January 2015 to June 2020,235 children with severe and above burns who met the inclusion criteria were hospitalized in the First Affiliated Hospital of Nanchang University,including 150 males and 85 females,aged 3 months to 12 years.After admission,it was planned to rehydrate the children with electrolyte,colloid,and water according to the domestic rehydration formula for pediatric burn shock,and the rehydration volume and speed were adjusted according to the children's mental state,peripheral circulation,heart rate,blood pressure,and urine output,etc.The actual input volume and planned input volume of electrolyte,colloid,water,and total fluid of all the children were recorded during the 8 hours since fluid replacement and the first and second 24 hours after injury.According to urine output during the 8 hours since fluid replacement,all the children were divided into satisfactory urine output maintenance group(119 cases)with urine output≥1 mL·kg^(-1)·h^(-1)and unsatisfactory urine output maintenance group(116 cases)with urine output<1 mL·kg^(-1)·h^(-1),and the electrolyte coefficient,colloid coefficient,and water coefficient of the children were calculated during the 8 hours since fluid replacement.According to the total burn area,children aged<3 years(155 cases)and 3-12 years(80 cases)were divided into 15%-25%total body surface area(TBSA)group and>25%TBSA group,respectively.The electrolyte coefficient,colloid coefficient,water coefficient,and urine output of the children were calculated or counted during the first and second 24 hours after injury,and the non-invasive monitoring indicators of body temperature,heart rate,respiratory rate,and percutaneous arterial oxygen saturation and efficacy indicators of hematocrit,platelet count,hemoglobin,albumin,creatinine,and alanine

关 键 词：烧伤 儿童 休克 补液疗法 疗效比较研究 无创监测 液体复苏 

分 类 号：R608[医药卫生—外科学] R758.71[医药卫生—临床医学]