控制大面积烧伤患者过度液体复苏预防并发症

郇京宁; 黄晓琴

doi:10.3760/cma.j.cn501120-20210813-00281

控制大面积烧伤患者过度液体复苏预防并发症

doi: 10.3760/cma.j.cn501120-20210813-00281

郇京宁^,,
黄晓琴

上海交通大学医学院附属瑞金医院烧伤整形科，上海　　200025

基金项目:

国家自然科学基金面上项目 81772077

国家自然科学基金青年科学基金项目 81801910

详细信息

通讯作者:
郇京宁，Email：jnhuan@sina.com

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出版历程
- 收稿日期: 2021-08-13

Controlling excessive fluid resuscitation in massive burn patients to prevent complications

Huan Jingning^,,
Huang Xiaoqin

Department of Burn and Plastic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Funds:

General Program of National Natural Science Foundation of China 81772077

Youth Science Foundation Project of National Natural Science Foundation of China 81801910

More Information

Corresponding author: Huan Jingning, Email: jnhuan@sina.com

摘要

摘要: 大面积烧伤患者过度液体复苏已是烧伤治疗中的常见现象，原因可能与伤后第1个24 h仅用电解质溶液复苏、追求血流动力学指标达到正常水平的目标导向性液体复苏策略等有关。过度液体复苏引起组织水肿是诱发呼吸功能不全、腹腔间室综合征等并发症的重要因素。对于大面积烧伤患者，应该从确定理想的复苏策略、设定合适的复苏目标值、实施复苏液体精细化管理等诸多方面入手，控制过度液体复苏，预防相关并发症。
- 烧伤 /
- 补液疗法 /
- 过度液体复苏 /
- 组织水肿 /
- 并发症
Abstract: Excessive fluid resuscitation in massive burn patients is a common phenomenon in burn management, and the reasons are mostly related with administering resuscitation of crystalloid alone and pursuing a goal-directed resuscitation with targeting normal hemodynamic parameters in the first 24 h post burn. Tissue edema caused by excessive fluid resuscitation is a vital factor that induces complications including respiratory compromise, abdominal compartment syndrome, and so on. Therefore, in order to control excessive fluid resuscitation and prevent its subsequent complications in massive burn patients, it is necessary to determine the optimal resuscitation regime, set appropriate resuscitation endpoints, and implement precise management of fluid resuscitation.
- Burns /
- Fluid therapy /
- Over- resuscitation /
- Tissue edema /
- Complication
所有作者均声明不存在利益冲突

该研究旨在评价腹腔复苏对烧伤合并失血小鼠生存时间的影响。模型制作：将C57BL/6J小鼠背部于90 ℃水浴中浸浴7 s造成30%TBSAⅢ度烫伤，立即腹腔注射生理盐水或腹膜透析液或不补液，然后通过股动脉放血将平均动脉压降至25 mm Hg（1 mmHg=0.133 kPa）并维持30 min，随后在15 min内通过静脉输注乳酸林格液或红细胞和新鲜冰冻血浆体积比1∶1混合液将收缩压恢复至80 mm Hg。上述复苏方案包括不补液联合乳酸林格液、不补液联合红细胞和新鲜冰冻血浆体积比1∶1混合液、生理盐水联合乳酸林格液、生理盐水联合红细胞和新鲜冰冻血浆体积比1∶1混合液、腹膜透析液联合乳酸林格液、腹膜透析液联合红细胞和新鲜冰冻血浆体积比1∶1混合液。结果显示，不补液联合乳酸林格液复苏的烫伤小鼠和不补液联合红细胞和新鲜冰冻血浆1∶1混合液复苏的烫伤小鼠的中位生存时间分别为1.47、2.08 h。烫伤后腹腔注射生理盐水或腹膜透析液可显著延长小鼠生存时间。生理盐水或腹膜透析液联合红细胞和新鲜冰冻血浆1∶1混合液复苏的烫伤小鼠液体需求量少于其他方案复苏烫伤小鼠。与腹腔注射腹膜透析液相比，腹腔注射生理盐水烫伤小鼠的TNF-α和巨噬细胞炎症蛋白1α水平较低，IL-10和肠型脂肪酸结合蛋白水平较高，并能延缓急性肺损伤的进展。

刘兆兴,编译自《Mil Med》, 2020, 185(9/10): e1528-e1535;申传安,审校

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