成人大面积烧伤后急救复苏十倍法补液公式的创建与应用  

Establishment and application of the tenfold rehydration formula for emergency resuscitation of adult patients after extensive burns

作　　者：申传安[1] 刘馨竹 李大伟[1] 刘兆兴 张博涵 Shen Chuan'an;Liu Xinzhu;Li Dawei;Liu Zhaoxing;Zhang Bohan(Department of Burns and Plastic Surgery,the Fourth Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第四医学中心烧伤整形医学部,北京100048

出　　处：《中华烧伤与创面修复杂志》2022年第3期236-241,共6页Chinese Journal of Burns And Wounds

基　　金：国家自然科学基金面上项目(82072169);军队后勤科研重大项目(ALB18J001)。

摘　　要：目的探讨成人大面积烧伤后急救复苏十倍法补液公式的科学性和可行性。方法采用回顾性观察性研究方法。收集解放军总医院第四医学中心2016年12月—2019年12月收治的170例大面积烧伤成年患者[男135例、女35例,年龄(42±14)岁]的烧伤总面积[30%~100%体表总面积(TBSA)]和体重(45~135 kg)资料。将45~135 kg中的每一体重(编程步长为1 kg)与烧伤总面积为30%~100%TBSA中的每一面积(编程步长为1%TBSA)配对后的6461对模拟数据,代入4个公认补液公式——Parkland公式、Brooke公式、解放军第三〇四医院公式和第三军医大学公式与2个急救补液公式——世界卫生组织烧伤技术工作小组(TWGB)提出的大面积烧伤患者急救简化复苏方案(以下简称TWGB公式)和该文作者提出的十倍法补液公式,计算伤后8 h内补液速度(以下简称补液速度),结果以烧伤总面积编程步长为10%TBSA进行展示。以4个公认补液公式的计算结果为合理补液速度,计算并比较采用2个急救补液公式计算的补液速度的准确率。利用烧伤总面积分别为30%、100%TBSA时采用十倍法补液公式计算结果为合理补液速度时对应的最大体重,将45~135 kg分为3个段,比较各个体重分段中采用2个急救补液公式计算的补液速度的准确率。当2个急救补液公式计算的补液速度均不合理时,比较两者补液速度的差异。统计前述170例患者中前述3个体重分段分布;利用前述170例患者的烧伤总面积和体重数据,同前计算并比较采用2个急救补液公式计算的补液速度的准确率。对数据进行McNemar检验。结果烧伤总面积分别为30%、40%、50%、60%、70%、80%、90%、100%TBSA时,体重为45~135 kg的情况下,采用2个急救补液公式计算的补液速度均没有超过4个公认补液公式的计算结果中的最大值;TWGB公式计算的补液速度不随烧伤总面积的变化而改变,十倍法补液公式计算的补液速度不随体�Objective To explore the scientificity and feasibility of the tenfold rehydration formula for emergency resuscitation of adult patients after extensive burns.Methods A retrospective observational study was conducted.The total burn area(30%-100%total body surface area(TBSA))and body weight(45-135 kg)of 170 adult patients(135 males and 35 females,aged(42±14)years)with extensive burns admitted to the Fourth Medical Center of PLA General Hospital from December 2016 to December 2019 were collected.The 6461 pairs of simulated data obtained after pairing each body weight in 45 to 135 kg(programmed in steps of 1 kg)with each area in 30%to 100%TBSA(programmed in steps of 1%TBSA)were plugged into four recognized rehydration formulas--Parkland's formula,Brooke's formula,the 304th PLA Hospital formula,and the Third Military Medical University formula and two emergency rehydration formulas--the simplified first aid resuscitation plan for extensive burn patients proposed by the World Health Organization's Technical Working Group on Burns(TWGB,hereinafter referred to as the TWGB formula)and the tenfold rehydration formula proposed by the author of this article to calculate the rehydration rate within 8 hours after injury(hereinafter referred to as the rehydration rate),with results being displayed by a programming step of 10%TBSA for the total burn area.Taking the calculation results of four recognized rehydration formulas as the reasonable rehydration rate,the accuracy of rehydration rates calculated by two emergency rehydration formulas were calculated and compared.The body weight of 45-135 kg was divided into three segments by the results of maximum body weight at a reasonable rehydration rate calculated by the tenfold rehydration formula when the total burn area was 30%and 100%TBSA,respectively.The accuracy of rehydration rate calculated by two emergency rehydration formulas in each body weight segment was compared.When the rehydration rates calculated by two emergency rehydration formulas were unreasonable,the differences

关 键 词：烧伤 休克 急救 十倍法补液公式 复苏 

分 类 号：R644[医药卫生—外科学]