特重型爆震伤患者的液体管理策略实践  

Fluid management strategies for patients with severe blast injury

作　　者：杨旻斐[1] 徐梦云 柯喻 卢骁[1] 张兰兰 姚晓月 Yang Minfei;Xu Mengyun;Ke Yu;Lu Xiao;Zhang Lanlan;Yao Xiaoyue(Department of Emergency Medicine,the Second Affiliated Hospital Zhejiang University School of Medicine,Hangzhou 310052,China;Department of Intensive Care Unit,the Second Affiliated Hospital Zhejiang University School of Medicine,Hangzhou 310052,China;Department of Geriatrics,Hangzhou Fuyang Sunshine Geriatric Hospital,Hangzhou 311400,China)

机构地区：[1]浙江大学医学院附属第二医院急诊科,杭州310052 [2]浙江大学医学院附属第二医院重症监护室,杭州310052 [3]杭州富阳阳光老年病医院老年科,杭州311400

出　　处：《中国实用护理杂志》2023年第14期1105-1109,共5页Chinese Journal of Practical Nursing

基　　金：浙江省康恩贝医院管理软科学研究项目(2021ZHA-KEB314)。

摘　　要：目的总结特重型爆震伤患者在急诊监护室治疗期间通过精准化液体管理经验,帮助患者平稳度过危险期顺利康复。方法基于2020年6月14日浙江大学医学院附属第二医院接收的6例槽罐车爆炸事件中患者的液体管理经验,其主要策略包括最佳液体容量管理方案的制订和阶段性调整;精准评估出入量、尿量和动态调整输液量和速度;监测肺部氧合功能、及时调整液体复苏策略;借助多种监测指标为液体管理提供护理管理策略依据。结果最终6例特重型爆震伤患者中5例经过分阶段精细化液体管理平稳度过休克期和感染期,病情好转康复出院;1例患者因伤势过重,经抢救无效死亡。结论采用个体化分阶段精细化液体管理策略对特重型爆震伤患者平衡度过危险期具有临床意义。Objective To summarize the precision fluid management of patients with severe blast injury in the emergency intensive care unit,so as to help patients smoothly pass through the dangerous period and recover smoothly.Methods Based on the experience of fluid management in 6 patients admitted to the Second Affiliated Hospital Zhejiang University School of Medicine in the tanker truck explosion on 14 June,2020.The main measures included:fluid volume management and dynamic adjustment;assessment of intake,output and urine volume,and dynamic adjustment of infusion volume and speed;monitoring of pulmonary oxygenation and timely adjustment of fluid resuscitation strategies;monitoring indexes and providing nursing care strategies for fluid management.Results Finally,among 6 patients with severe blast injury,5 patients were discharged from the hospital with follow-up treatment after they suffered from the shock and infection phases and refined fluid management,1 patient died due to severe injury and ineffective rescue.Conclusions Adopting individualized,phased,and refined liquid management strategy has clinical significance for patients with severe blast injury to smoothly pass the risk period.

关 键 词：护理 爆震伤 液体管理 

分 类 号：R473.6[医药卫生—护理学]