休克期切痂对大面积烧伤病人能量消耗的影响

目的观察休克期切痂植皮对烧伤病人能量消耗的影响。方法对２１例烧伤面积大于３０％的深度烧伤病人，依休克期切痂与否分为休克期切痂植皮组（１５例）和非休克期切痂植皮组（６例），所有病人在治疗期间应用新型代谢车床旁动态监测病人静息能量消耗（ＲＥＥ）变化。结果休克期切痂植皮组和非休克期切痂植皮组病人在年龄结构、烧伤总面积、Ⅲ度烧伤面积、首次切痂面积等方面基本一致（Ｐ＞０．０５），尽管两组病人ＲＥＥ均明显升高，２周时休克期切痂组为（３１１±１５）Ｊ·ｈ－１·ｍ－２，非休克期切痂组为（３４５±１６）Ｊ·ｈ－１·ｍ－２。但休克期切痂植皮组由于及时切痂植皮封闭创面，病人在伤后２周内ＲＥＥ明显低于非休克期切痂植皮组，且休克期切痂植皮组病人在切痂前、切痂后ＲＥＥ均显著低于非休克期切痂组。结论严重深度烧伤病人休克期切痂植皮可在一定程度上降低机体的高代谢状态。

The effects of escharectomy during burn shock stage on metabolic rate alterations

Objective To determine whether early massive eschar excision and skin grafting may decrease the hypermetabolic response that characterizes burn injury. Method Twentyone adult men with burns over 30% of the total body surface area were assigned to one of two treatment groups. Resting energy expenditures (REEs) were obtained by means of cardiorespiratory diagnostic systems (made by Medical Graphics Corporation in USA) at the patients bedsides. Results The clinical conditions and nonoperative management in two groups were comparable , but different in time of eschar excision and skin grafting. Although REEs increased sharply in all patients, the patients in group 1 with escharectomy during burn shock stage had lower REEs than those in group 2 with escharectomy after burn shock stage. Conclusion Escharectomy during burn shock stage contribute to decreasing the hypermetabolic response to burn injury.