严重烧伤早期应用不同浓度含钠复苏液对机体内环境的影响

目的 探讨严重烧伤早期应用不同浓度含钠复苏液对机体内环境的影响。方法 35例烧伤面积（总面积/Ⅲ度面积）为50％－100％／20％－88％的患，根据输入液体中电解质含量的不同分为A组（17例，含钠量174mmol/L)和B组（17例，含钠量130mmol/L)。于伤后1－5d观察患的液体输入量、血浆电解质渗透压、血浆白蛋白／球蛋白比值、尿量及其pH值和全身水肿程度。结果 A组3d内平均每小时输入量较B组少20－30ml；5d内A组钠离子总输入量高于B组；A组肾脏钠滤过分数5d内均在正常范围内，而B组低于正常，说明这与钠离子输入较少、水输入过多有关。结论 早期电解质复苏液中钠离子的浓度和水的负荷对机体内环境有较大的影响，应用复方乳酸钠林格液于胶体＋电解质型公式补液时，其补水量应相应减少。

The influence of resuscitation with solutions containing different concentrations of sodium on the homeostasis of burn patients during the early postburn stage

OBJECTIVE: To investigate the influence of resuscitation with solutions containing different concentrations of sodium on the homeostasis of burn patients during the early postburn stage. METHODS: Thirty-five cases of burn patients inflicted with 50% approximately 100% of TBSA including 20% approximately 88% of 3rd degree burn were enrolled in the study. All the patients studied were divided into A[(Na+) = 174 mmol/L] and B [(Na+) = 130 mmol/L] groups according to different concentrations of sodium in the infusion solution. The input of the fluid, plasma crystal osmotic pressure, plasma ratio of albumin to globulin, urine output and pH value and anasarcous degree were observed during 1 to 5 postburn days (PBDs). RESULTS: The infusion fluid amount per hour in A group was 20 approximately 30 ml less than that in B group within 3 PBDs. The infused sodium amount in A group was more than that in B group within 5 PBDs. The FENa in A group was in normal range within 5 PBDs, while that in B group was lower than normal. This might be related to different infusion amounts of water and sodium. CONCLUSION: The homeostasis of burn patients could be significantly affected by the water load and the sodium concentration in the resuscitation solution during early postburn stage.