小儿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 ten-fold rehydration formula for emergency resuscitation of pediatric patients after extensive burns

作　　者：申传安[1] 刘馨竹 谢晓烨 张博涵 李大伟[1] 刘兆兴 袁华庚 Shen Chuan'an;Liu Xinzhu;Xie Xiaoye;Zhang Bohan;Li Dawei;Liu Zhaoxing;Yuan Huageng(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》2023年第1期59-64,共6页Chinese Journal of Burns And Wounds

基　　金：国家自然科学基金面上项目(82072169,82272279);军队后勤科研重大项目(ALB18J001);保健专项科研课题重点项目(22BJZ35)。

摘　　要：目的探讨研究小儿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2014年1月1日—12月31日国内72家三级甲等医院烧伤科收治的符合入选标准的433例大面积烧伤患儿(男250例、女183例,年龄3个月龄~14岁)的烧伤总面积[30%~100%体表总面积(TBSA)]和体重(6~50 kg)。将6~50 kg中的每一体重(编程步长为0.5 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6319对模拟数据,代入3个公认小儿补液公式——国内常用的小儿烧伤补液公式(以下简称国内补液公式)、加尔维斯顿公式和辛辛那提公式与2个小儿急救补液公式——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)和该文作者提出的小儿十倍法补液公式:补液速度(mL/h)=体重(kg)×10(mL·kg^(-1)·h^(-1)),计算伤后8 h内补液速度(以下简称补液速度)。以3个公认小儿补液公式的计算结果±20%的范围为合理补液速度,计算并比较采用2个小儿急救补液公式计算的补液速度的准确率。利用体重分别为6、50 kg时采用小儿十倍法补液公式计算结果为合理补液速度时对应的最大烧伤面积(55%、85%TBSA),将烧伤总面积30%~100%TBSA分为3个段,比较各分段中采用2个小儿急救补液公式计算的补液速度的准确率。当2个小儿急救补液公式计算的补液速度均不合理时,比较2种补液速度的差异。统计433例患儿前述3个烧伤总面积分段分布情况,计算并比较2个小儿急救补液公式计算的补液速度的准确率。对数据行McNemar检验。结果将6319对模拟数据代入显示,小儿十倍法补液公式计算的补液速度准确率为73.92%(4671/6319),显著高于TWGB公式的4.02%(254/6319),χ^(2)=6490.88,P<0.05。当烧伤总面积为30%~55%TBSA、56%~85%TBSA时,采用小儿十倍法补液公式计算的补液速度的准确�Objective To investigate the scientificity and feasibility of the ten-fold rehydration formula for emergency resuscitation of pediatric patients after extensive burns.Methods A retrospective observational study was conducted.The total burn area of 30%-100%total body surface area(TBSA)and body weight of 6-50 kg in 433 pediatric patients(250 males and 183 females,aged 3 months to 14 years)with extensive burns who met the inclusion criteria and admitted to the burn departments of 72 Class A tertiary hospitals were collected.The 6319 pairs of simulated data were constructed after pairing each body weight of 6-50 kg(programmed in steps of 0.5 kg)and each total burn area of 30%-100%TBSA(programmed in steps of 1%TBSA).They were put into three accepted pediatric rehydration formulae,namely the commonly used domestic pediatric rehydration formula for burn patients(hereinafter referred to as the domestic rehydration formula),the Galveston formula,and the Cincinnati formula,and the two rehydration formulae for pediatric emergency,namely the simplified resuscitation formula for emergency care of patients with extensive burns proposed by the World Health Organization's Technical Working Group on Burns(TWGB,hereinafter referred to as the TWGB formula)and the pediatric ten-fold rehydration formula proposed by the author of this article--rehydration rate(mL/h)=body weight(kg)×10(mL·kg^(-1)·h^(-1))to calculate the rehydration rate within 8 h post injury(hereinafter referred to as the rehydration rate).The range of the results of the 3 accepted pediatric rehydration formulae±20%were regarded as the reasonable rehydration rate,and the accuracy rates of rehydration rate calculated using the two pediatric emergency rehydration formulae were compared.Using the maximum burn areas(55%and 85%TBSA)corresponding to the reasonable rehydration rate calculated by the pediatric ten-fold rehydration formula at the body weight of 6 and 50 kg respectively,the total burn area of 30%to 100%TBSA was divided into 3 segments and the accuracy rates

关 键 词：儿童 烧伤 休克 急救 十倍法补液公式 

分 类 号：R644[医药卫生—外科学] R605[医药卫生—临床医学]