烧伤休克期有关补液公式的临床应用与评价

目的 评价第三军医大学烧伤休克期补液公式(简称三医大公式)在大面积烧伤患者休克防治中的应用.方法 选择2005-2007年笔者单位收治的热力烧伤患者(烧伤总面积大于或等于30%TBSA、伤后8 h内入院且无特殊疾患)共71例,分为成人组(46例)、小儿组(25例).患者入院后即按照三医大公式进行液体复苏治疗,同时监测尿量、心率、血压等指标,根据患者实际情况随时调整补液速度.记录并统计2组患者补液量、实际补液系数、尿量. 结果 71例患者均平稳度过休克期,未发生明显的因液体复苏引起的相关并发症.成人组伤后第1、2个24 h及小儿组伤后第2个24 h的实际补液量超过各自计划补液量的16%～38%.成人组第1、2个24 h的实际补液系数大于公式所要求的补液系数.2组患者第1个24 h尿量为1.1～1.2 mL·kg-1·h-1左右;第2个24 h成人组为(1.2±0.4)mL·kg-1·h-1,小儿组为(1.7±0.5)mL·kg-1·h-1. 结论 三医大公式是大面积烧伤患者休克期治疗的较好选择,在应用此公式时须强调进行个性化液体复苏治疗.

Clinical practice and evaluation of relative fluid resuscitation formula at bum shock stage

Objective To evaluate the application of the Third Military Medical University (TMMU) formula for fluid resuscitation on the major burn patients during shock stage. Methods Seventy-one ther- mal injury patients (burn area more than 30% TBSA,without especial illness, hospitalization within 8 hour after burn ) admitted from 2005 to 2007 were divided into adult group ( n = 46) ,child group( n = 25 ). Fluid resuscitation was initiated as per the TMMU formula. Results All patients survived the first 48 hours post bum injury and none developed recognized complications associated with fluid resuscitation. The average in- fused fluid was 16% ～ 38% more than the calculated in both adult and child groups. The average urine out- put during the first 24 hours post burn injury was 1.1 ～ 1.2 mL · kg-1 · h-1 in the two groups, but reached 1.2 mL and 1.7 mL · kg-1 · h-1 during the second 24 hours in adult and child groups respectively. Con- clusion TMMU formula for fluid resuscitation is a feasible option for major burn patients. Individual fluid resuscitation, guided by the physiological response, is also important and necessary.