烧伤手术失血量估计的主客观差异及意义

对1993～1995年39例烧伤总面积平均48％(16～96％),三度面积21％(5～80％)病人共71次切痴及肉芽清创手术进行分析,发现为保持病人手术中生命体征平稳,每1％创面手术面积输血量在切痴组为65ml,在肉芽手术组为50ml,每1％总手术面积输血量在切痂组为42ml,在肉芽及剥痂组为30ml。术后肉芽手术组血红蛋白无明显变化,切痂组病人血红蛋白较术前低22g/L,按此计算每1％创面手术面积失血量为130ml,每1％总手术为89ml。由于术者术后对失血量的估计普遍显著低于输血量,从而对术者在心理上造成错觉,认为补充量已满足了失血量,在进行补救前病人已经受48小时以上的贫血状态,有可能影响植皮成活。

The problems in subjective judgment of blood loss during burn wound surgery

Fifteen primary excisions and 57 granular wound debridement both with split skin graft were performed in 39 burned patients. In order to maintain vital signs during operation,the blood transfusion volumes were 42 ml per 1% burn excised and autografted or 65 ml per 1% burn excised only. It needed 50ml per 1% debrided and split skin donor or 30 ml per debrided alone within granular wound. Postoperative haemoglobin reduced by 22 g/L in primary excised surgery but not in debrided one compared with preopera-tive level. According to changes of Hb calculated blood loss was 130 ml per 1 % burn excised and autografted or 89 ml per 1% burn excised only, either more than actual transfusion volume significantly. Problems were arisen due to blood lose estimated even lower than transfusion one.