烧伤后早期应用不同液体复苏血钠和红细胞变化的临床研究

目的　观察烧伤后早期应用不同液体复苏患者血钠和红细胞的变化。方法　将 15 0例烧伤患者分为 3组 ,A组为中、小面积烧伤患者 5 0例 ,给予平衡盐溶液 (钠离子 130mmol/L)复苏 ;B组为大面积烧伤患者 5 0例 ,液体复苏方法同A组 ;C组为大面积烧伤患者 5 0例 ,给予高渗乳酸钠溶液 (钠离子 174mmol/L)复苏。观察伤后 1～ 3d患者的补液总量、血钠、红细胞数量及红细胞平均体积 (MCV)的变化。对A、B组患者的烧伤指数 (BI)与其伤后 1d的血钠值作相关性分析。　 结果　伤后 3d内A组患者补液总量、补钠量均低于其他两组 (P <0.0 1);C组补液总量低于B组 ,而补钠量多于B组 (P <0.0 1)。伤后 3d内B组血钠值接近正常值下限 ,C组血钠值接近正常值上限 ,前者明显低于后者 (P <0.0 5或 0 .0 1)。伤后 3d内B、C组的红细胞数量相近 (P >0.0 5 )。伤后 1dB、C组患者的MCV分别为 (95 .5± 5 .5 )、(92 .1± 4 .5 )fl,伤后 2d各为 (93.2± 6 .4 )、(90 .9± 5 .4 )fl,组间比较差异无显著性意义 (P >0.0 5 )。A、B组患者伤后 1d的血钠值与自身BI呈负相关 (r=- 0 84,P<0.0 1)。　 结论　大面积烧伤患者伤后早期采用高渗盐溶液复苏 ,血钠值平稳且红细胞的肿胀程度较轻

Clinical study on the changes in plasma sodium level and blood erythrocyte after resuscitation with different fluid regimes at early postburn stage

OBJECTIVE: To study the changes in plasma sodium level and blood erythrocyte after resuscitation with different fluid regimes at early postburn stage. METHODS: One hundred and fifty burn patients admitted to our burn ward were randomly divided into three groups based on the different regimes of fluid resuscitation, i.e. A (n = 50, resuscitation with balanced salt solution for to the patients with middle and small burn area, Na(+) = 130 mmol/L); B (n = 50, with the same regime as in group A for those with large burn area), and C (n = 50, with hypertonic saline resuscitation for those with large burn area, Na(+) = 174 mmol/L) groups. The fluid supplementation, and changes in plasma sodium level and blood erythrocyte count, and the mean corpuscular volume (MCV) were observed during 1st to 3rd post burn day (PBD). RESULTS: The average volume of fluid supplementation in C group was lower than that in A and B groups (P < 0.01), though the average sodium supplementation in C group was higher than that in B group within 3 PBDs (P < 0.01). The average plasma level of sodium in B group was obviously lower than that in C group within 3 PBDs (P < 0.05). Negative correlation between the plasma sodium level and burn index (BI) was observed in A and B group on 1 PBD (r = -0.84, P < 0.01). The plasma sodium level was in the lower margin of normal range (137.4 +/- 3.9) mmol/L in B group, while that in C group was in the higher margin of normal range with obvious difference compared with B and C groups (P < 0.05 or 0.01). The MCV in group was lower than that in B group on the 1st and 2nd PBD, i.e. (92.1 +/- 4.5) fl vs (95.5 +/- 5.5) fl on the 1st PBD, and (90.9 +/- 5.4) fl vs (93.2 +/- 6.4) fl on the 2nd PBD, P > 0.05). CONCLUSION: The plasma sodium level was stable with milder degree of swelling of the erythrocytes when hypertonic saline resuscitation was given to patients with large burn area during early postburn stage.