大面积烧伤休克期液体复苏探讨

目的探讨大面积烧伤休克期液体复苏的方法与输液技术。方法本研究基于63例大面积烧伤患者，统计伤后第1个24h每小时1％TBSA输液量（Aq）和体表面积（BSA），以Aq、BSA和烧伤面积指数（BAI）为参数，产生补液公式Q=∑△q（0．55BSA×BAI）。然后，用新公式和中国液体复苏公式分别计算补液量，进行对比分析。结果伤后3h～8hAq分别为10ml·h^-1·1％TBSA^-1、9ml·h·1％TBSA^-1、8ml．h^-1·1％TBSA^-1、7ml·h^-1-1％TBSA^-1、6ml·h^-1·1％TBSA、5ml-h^-1.1％TBSA^-1;9h～12h各为4ml·h^-1·1％TBSA～；后12h各为3ml·h^-1·1％TBSA；伤后第1h、2h分别取6ml·h^-1·1％TBSA^-1、7ml·h^-1·1％TBSA^-1。新公式计算全天总量为8074ml，即1．53ml·kg^-1·1％TBSA^-1：各时段补给量占全天总量的比率与63例患者的实际补液量比率基本相符。伤后第2d，△q值为2．5ml·h^-1·1％TBSA^-1～3nil·h^-1·1％TBSA^-1。结论新公式较好地解决了体重和烧伤面积相对性对估算补液量的影响、输液速度控制及累积丢失量补给等问题，证实了液体复苏新公式优于传统复苏公式。

Study on Fluid Resuscitation of Extensive Burns at Shock Stage

Objective To explore the method of fluid resuscitation and the transfusion technique for extensive burns at shock stage. Methods The transfusion volume of every 1% TBSA per hour （△ q） and Body Surface Area （BSA） for the first 24 hours post-burn was counted in sixty-three patients with extensive burns. With A q, BSA and burn area index （BAD as parameters, a new formula for fluid replacement was made as Q = ∑△q （0. 55BSA× BAI）. And then fluid re- placement volumes were calculated with the new fommla and Chinese Fluid Resuscitation Formula respectively and the corre- sponding results were compared and analyzed. Results During 3 -8 hours postburn, the Aq were respectively 10, 9, 8, 7, 6, 5 （ml·h^-1· 1% TBSA 1）; between9-12 hourspostburn, Aqwere all4 ml · h^-1·1% TBSA^-1; during the latter half of the first 24 hours postburn, A q remained at 3 ml · h^-1· 1% TBSA^-1 ; A q at the first hour and the second hour were 6 ml · h^ - 1 . 1% TBSA i and 7 ml · h ^- 1 . 1% TBSA - 1 respectively. The total volume of fluid replacement for a whole day was 8074ml （equivalently 1.53 ml · kg^-1· 1% TBSA^-1 ） when calculated using the new formula. The ratio of the fluid replacement volume per time intervals to the total volume of a day was almost the same with the ratio of actual fluid replacement volume of the 63 patients. On the 2nd day postburn, the Aq ranged from 2. 5 ml · h^-1· 1% TBSA^-1 - 3 ml ·h^- 1· 1% TBSA^-1. Conclusion The new formula can well solve such problems as the influence of body weight/TBSA on the estimation of fluid replacement volume, the control of infusion speed and the replacement of cumulative fluid loss and etc. Thus, the new formula for fluid resuscitation is superior to the traditional Chinese Fomaula.