55例严重烧伤休克延迟复苏患儿补液方案分析

目的探讨严重烧伤休克延迟复苏患儿的补液方案,并分析其相关影响因素。方法回顾性分析2012年4月至2017年4月安徽医科大学第一附属医院收治的55例严重烧伤休克延迟复苏患儿的临床资料及液体复苏方案,对比补液前后患儿尿量、血红蛋白、红细胞比容变化情况,以及不同延迟复苏时间、年龄、烧伤面积、烧伤深度患儿第1个24 h平均补液量及尿量。结果根据患儿症状、体征、血生化指标以及临床监测指标对补液量及补液速度做出适当调整后,补液前8 h实际补液量为第1个24 h公式计算量的(94.8±37.1)%,第1个24 h实际补液量为第1个24 h公式计算量的(112.6±34.8)%,第2个24 h实际补液量为第2个24 h公式计算量的(78.1±23.6)%;补液后8、24、48、72 h患儿尿量均较补液前明显增多(t=5.733、13.283、17.437、14.371,P均=0.000),补液后24 h患儿血红蛋白及红细胞比容均较补液前明显降低(t=3.875、4.411,P均=0.000);年龄<3岁及烧伤面积≤30%TBSA患儿第1个24 h平均补液量明显多于年龄≥3岁、烧伤面积>30%TBSA者(t=7.117、5.662,P均=0.000);年龄<3岁患儿第1个24 h平均尿量明显多于年龄≥3岁者(t=4.803,P=0.000)。结论严重烧伤休克延迟复苏患儿液体复苏过程中应综合考虑年龄、烧伤面积等因素对补液量的影响,实施个体化液体复苏方案,而不能完全遵循补液公式。

Analysis of Fluid Infusion Therapy for 55 Severe Burn Child Patients Who Received Delayed Resuscitation after Burn Shock

Objective To explore fluid infusion therapy for child patients who received delayed resuscitation after burn shock and analyze the related influencing factors on the therapy.Methods The clinical data of 55 severe burn child patients,who were admitted to the First Affiliated Hospital of Anhui Medical University from April 2012 to April 2017 and received delayed resuscitation,was retrospectively analyzed.The changes of urine volume,hemoglobin and hematocrit value before and after fluid infusion,fluid infusion volume and urine volume for patients at different ages with different delayed resuscitation time,burn depth,burn area at first 24 h were compared.Results Based on the signs and symptoms,blood biochemical indicators and clinical test indicators of child patients,the volume and speed of fluid infusion were adjusted.The actual fluid infusion volume within 8 h was(94.8±37.1)% of the amount obtained from the formula at the first 24 h.The actual fluid infusion volume within 24 h was(112.6±34.8)% of the amount obtained from the formula at the first 24 h.The actual fluid infusion volume within the second 24 h was(78.1±23.6)% of the amount obtained from the formula at the second 24 h.The urinary volume at 8,24,48 and 72 h after fluid infusion was significantly higher than before fluid infusion(t=5.733,13.283,17.437,14.371,all P=0.000),and the hemoglobin and hematocrit value 24 h after fluid infusion were significantly lower than before fluid infusion(t= 3.875,4.411,all P=0.000);at the first 24 h,fluid infusion for child patients aged less than 3 years with burn area≤30% TBSA was significantly more than those at the age of 3 or older with burn area> 30% TBSA(t=7.117,5.662,all P=0.000);the average urine volume of children less than 3 years old at the first 24 h was significantly greater than those at the age of 3 or older(t=4.803,P=0.000).Conclusion During fluid infusion for severe child patients who received delayed resuscitation after burn shock,the influence of such factors as age and burn area on the volume of fluid infusion should be taken into consideration so as to make fluid infusion therapy more personalized.Determination of fluid volume only based on formula should be avoided.