合并休克期呼吸心跳骤停的大面积烧伤救治体会

目的：回顾总结救治1例合并休克期呼吸心跳骤停的大面积烧伤的成功救治经验。方法：对1例火焰烧伤总面积96％TBsA（深Ⅱ度4％；Ⅲ、Ⅳ度92％）合并吸入性损伤、休克期（伤后27h）呼吸心跳骤停的患者，早期重要治疗包括合理的补液治疗，早期气管切开，心肺复苏治疗；早期切痂手术，自体微粒皮、异体大张皮覆盖创面；此外，营养支持、抗感染治疗也贯穿了治疗整个过程。结果：患者在休克期出现呼吸心跳骤停，经过及时、成功的心肺复苏治疗，在密切监测生命指标的前提下，采取早期分二次切痂自体微粒皮、异体大张皮移植；由于自体皮源的缺乏，后期分11次手术自体皮移植封闭创面，经过128天创面愈合，治愈出院。结论：对于休克期出现呼吸心跳骤停的大面积深度烧伤的患者，个体化的补液治疗、及时有效地心肺复苏是救治成功的前提；在心肺复苏之后，选择合适的手术时机，重视围手术期的治疗，早期切痂手术，自体微粒皮、异体大张皮覆盖创面仍然是可行的，并且对稳定病情，减少并发症非常重要。同时，积极营养治疗并且尽早向肠内营养过度，防治感染，及时有效利用有限的自体皮源封闭创面同样必不可少。

Experiences in management of massive and deep burn patient with cardiopulmonary arrest in shock stage

Objective： To summarize the experiences in treatment of massive and deep burn patient with cardiopulmonary arrest in shock stage. Methods： A patient with 96 % TBSA flame burn injury（deep second degree 4 %; Ⅲ , Ⅳ degree 92 %）, complicated with moderate inhalation injury and cardiopulmonary arrest in shock stage. The primary treatment included optimal fluid resuscitation, early tracheotomy, cardiopulmonary resuscitation（CPR）, early eschareetomy, autologous micoroskin grafting and alloskin grafting. In addition, enteral nutrition support and reasonable antibiotics therapy were also adopted. Results： Immediate and successful CPR was performed when cardiopulmonary arrest occurred in massive and deep burn patient who was in shock stage. And then,after correct and effective preoperative preparation,tow times early eschareetomy,autologous micoroskin grafting and alloskin grafting were performed. Because of the lack of autoskin donor site, 11 times autoskin graft operations were undertaken when the autoskin donor was available. Finally the wounds healed completely after 128 days and the patient survived. Conclusions： For those patients with massive burns and cardiopulmonary arrest in shock stage,individualization fluid resuscitation,immediate and successful CPR was the basis of rescuing. And after CPR, choosing best time to operation, enhancing systemic supporting treatment in perioperative period, early escharectomy was feasible and essential to stabilize the patients＇ condition and reduce complications. Infection control,internal organ complication management and nutrition support were also essential.