烧伤患者休克期切痂的血流动力学变化

目的：探讨烧伤患者临床休克期进行切痂的安全性及可行性。方法：５０例大面积烧伤患者随机分为研究组和对照组。研究组按照血流动力学监测结果进行复苏，血流动力学平稳后４８小时内行首次切痂术；对照组用传统方法复苏，３～５日后行切痂术。结果：２１例患者〔烧伤体表总面积（ＴＢＳＡ）６２．８％±１２．６％，Ⅲ度烧伤面积３７．３％±１８．７％〕进入研究组，伤后（２６±１５）小时行切痂术。第１和第２个２４小时输液量高于标准计算公式约３０％以上。血流动力学监测显示，术后４８小时心脏指数（ＣＩ）明显高于术前〔（７．９±２．２）Ｌ·ｍｉｎ－１·ｍ－２比（４．４±１．２）Ｌ·ｍｉｎ－１·ｍ－２，Ｐ＜０．０１〕，其主要原因是由于每搏指数的改善所致，二者相关密切（ｒ＝０．８９，Ｐ＜０．０１）。与对照组比较，休克期切痂具有消灭创面早、后期并发症少和病程短等优点。结论：对大面积烧伤患者在血流动力学监测指导下进行复苏，选择性地实施休克期切痂是安全可行的。

Hemodynamic study of escharectomy in shock period in burned patients

Objective :To study hemodynamics of escharectomy in shock period,and evaluate the safety of this surgical procedure. Methods :50 extensive burned patients were divided into study and control groups.In the study group (n=21),the first escharectomy was performed after hemodynamic stability.Traditional surgical procedures were performed in another 29 patients as controls,and escharectomy was made on days 3 to 5 postburn. Results :In study group,21 burned patients with total body surface area 6286% and full thickness 3737% were resuscitated under hemodynamic monitoring,and the time of first escharectomy was at (2615) hours postburn.The volume of infusion was more than 30% as compared with control group in first and second 24 hours.Its cardiac index was significantly high at 48 hours post operation compared with pre operation (7922)Lmin-1m-2 vs.(4412) Lmin-1m-2,P<001,which attributed to the improvement of stroke index(r=089,P<001). Conclusions :Following resuscitation under hemodynamic monitoring,