小儿大面积烧伤后急救复苏十倍法补液公式的创建与应用

申传安; 刘馨竹; 谢晓烨; 张博涵; 李大伟; 刘兆兴; 袁华庚

doi:10.3760/cma.j.cn501120-20211111-00384

小儿大面积烧伤后急救复苏十倍法补液公式的创建与应用

doi: 10.3760/cma.j.cn501120-20211111-00384

解放军总医院第四医学中心烧伤整形医学部，北京　　100048

基金项目:

国家自然科学基金面上项目 82072169, 82272279

军队后勤科研重大项目 ALB18J001

保健专项科研课题重点项目 22BJZ35

详细信息

通讯作者:
申传安，Email：shenchuanan@301hospital.com.cn

计量
- 文章访问数: 279
- HTML全文浏览量: 177
- PDF下载量: 52
- 被引次数: 0
出版历程
- 收稿日期: 2021-11-11

Establishment and application of the ten-fold rehydration formula for emergency resuscitation of pediatric patients after extensive burns

Department of Burns and Plastic Surgery, the Fourth Medical Center of PLA General Hospital, Beijing 100048, China

Funds:

General Program of National Natural Science Foundation of China 82072169, 82272279

Major Program of Military Logistics Research Plan ALB18J001

Major Program of Healthcare Special Project 22BJZ35

More Information

Corresponding author: Shen Chuan'an, Email: shenchuanan@301hospital.com.cn

摘要

摘要: 目的探讨研究小儿大面积烧伤后急救复苏十倍法补液公式的科学性和可行性。方法采用回顾性观察性研究方法。收集2014年1月1日—12月31日国内72家三级甲等医院烧伤科收治的符合入选标准的433例大面积烧伤患儿（男250例、女183例，年龄3个月龄~14岁）的烧伤总面积［30%~100%体表总面积（TBSA）］和体重（6~50 kg）。将6~50 kg中的每一体重（编程步长为0.5 kg）与烧伤总面积为30%~100%TBSA中的每一面积（编程步长为1%TBSA）配对后的6 319对模拟数据，代入3个公认小儿补液公式——国内常用的小儿烧伤补液公式（以下简称国内补液公式）、加尔维斯顿公式和辛辛那提公式与2个小儿急救补液公式——世界卫生组织烧伤技术工作小组（TWGB）提出的大面积烧伤患者急救简化复苏方案（以下简称TWGB公式）和该文作者提出的小儿十倍法补液公式：补液速度（mL/h）=体重（kg）×10（mL·kg^-1·h^-1），计算伤后8 h内补液速度（以下简称补液速度）。以3个公认小儿补液公式的计算结果±20%的范围为合理补液速度，计算并比较采用2个小儿急救补液公式计算的补液速度的准确率。利用体重分别为6、50 kg时采用小儿十倍法补液公式计算结果为合理补液速度时对应的最大烧伤面积（55%、85%TBSA），将烧伤总面积30%~100%TBSA分为3个段，比较各分段中采用2个小儿急救补液公式计算的补液速度的准确率。当2个小儿急救补液公式计算的补液速度均不合理时，比较2种补液速度的差异。统计433例患儿前述3个烧伤总面积分段分布情况，计算并比较2个小儿急救补液公式计算的补液速度的准确率。对数据行McNemar检验。结果将6 319对模拟数据代入显示，小儿十倍法补液公式计算的补液速度准确率为73.92%（4 671/6 319），显著高于TWGB公式的4.02%（254/6 319），χ²=6 490.88，P<0.05。当烧伤总面积为30%~55%TBSA、56%~85%TBSA时，采用小儿十倍法补液公式计算的补液速度的准确率分别为100%（2 314/2 314）、88.28%（2 357/2 670），均显著高于TWGB公式的10.98%（254/2 314）、0（0/2 670），χ²值分别为3 712.49、4 227.97，P<0.05；当烧伤总面积在86%~100%TBSA时，小儿十倍法补液公式和TWGB公式计算的补液速度的准确率均为0（0/1 335）。当2个小儿急救补液公式计算的补液速度均不合理时，采用小儿十倍法补液公式计算的补液速度均大于TWGB公式。433例患儿中，烧伤总面积在30%~55%、56%~85%、86%~100%TBSA者所占比例分别为93.07%（403/433）、5.77%（25/433）、1.15%（5/433），采用小儿十倍法补液公式计算的补液速度准确率为97.69%（423/433），明显高于TWGB公式的0（0/433），χ²=826.90，P<0.05。结论应用小儿十倍法补液公式估算小儿大面积烧伤后补液速度相对准确、简便，优于TWGB公式，适合非烧伤专业的一线医护人员院前抢救大面积烧伤患儿时应用，值得推广。
- 儿童 /
- 烧伤 /
- 休克 /
- 急救 /
- 十倍法补液公式
Abstract: Objective To investigate the scientificity and feasibility of the ten-fold rehydration formula for emergency resuscitation of pediatric patients after extensive burns. Methods A retrospective observational study was conducted. The total burn area of 30%-100% total body surface area (TBSA) and body weight of 6-50 kg in 433 pediatric patients (250 males and 183 females, aged 3 months to 14 years) with extensive burns who met the inclusion criteria and admitted to the burn departments of 72 Class A tertiary hospitals were collected. The 6 319 pairs of simulated data were constructed after pairing each body weight of 6-50 kg (programmed in steps of 0.5 kg) and each total burn area of 30%-100% TBSA (programmed in steps of 1%TBSA). They were put into three accepted pediatric rehydration formulae, namely the commonly used domestic pediatric rehydration formula for burn patients (hereinafter referred to as the domestic rehydration formula), the Galveston formula, and the Cincinnati formula, and the two rehydration formulae for pediatric emergency, namely the simplified resuscitation formula for emergency care of patients with extensive burns proposed by the World Health Organization's Technical Working Group on Burns (TWGB, hereinafter referred to as the TWGB formula) and the pediatric ten-fold rehydration formula proposed by the author of this article--rehydration rate (mL/h)=body weight (kg) × 10 (mL·kg^-1·h^-1) to calculate the rehydration rate within 8 h post injury (hereinafter referred to as the rehydration rate). The range of the results of the 3 accepted pediatric rehydration formulae ±20% were regarded as the reasonable rehydration rate, and the accuracy rates of rehydration rate calculated using the two pediatric emergency rehydration formulae were compared. Using the maximum burn areas (55% and 85% TBSA) corresponding to the reasonable rehydration rate calculated by the pediatric ten-fold rehydration formula at the body weight of 6 and 50 kg respectively, the total burn area of 30% to 100% TBSA was divided into 3 segments and the accuracy rates of the rehydration rate calculated using the 2 pediatric emergency rehydration formulae in each segment were compared. When neither of the rehydration rates calculated by the 2 pediatric emergency rehydration formulae was reasonable, the differences between the two rehydration rates were compared. The distribution of 433 pediatric patients in the 3 previous total burn area segments was counted and the accuracy rates of the rehydration rate calculated using the 2 pediatric emergency rehydration formulae were calculated and compared. Data were statistically analyzed with McNemar test. Results Substitution of 6 319 pairs of simulated data showed that the accuracy rates of the rehydration rates calculated by the pediatric ten-fold rehydration formula was 73.92% (4 671/6 319), which was significantly higher than 4.02% (254/6 319) of the TWGB formula (χ²=6 490.88,P<0.05). When the total burn area was 30%-55% and 56%-85% TBSA, the accuracy rates of the rehydration rates calculated by the pediatric ten-fold rehydration formula were 100% (2 314/2 314) and 88.28% (2 357/2 670), respectively, which were significantly higher than 10.98% (254/2 314) and 0 (0/2 670) of the TWGB formula (with χ² values of 3 712.49 and 4 227.97, respectively, P<0.05); when the total burn area was 86%-100% TBSA, the accuracy rates of the rehydration rates calculated by the pediatric ten-fold rehydration formula and the TWGB formula were 0 (0/1 335). When the rehydration rates calculated by the 2 pediatric emergency rehydration formulae were unreasonable, the rehydration rates calculated by the pediatric ten-fold rehydration formula were all higher than those of the TWGB formula. There were 93.07% (403/433), 5.77% (25/433), and 1.15% (5/433) patients in the 433 pediatric patients had total burn area of 30%-55%, 56%-85%, and 86%-100% TBSA, respectively, and the accuracy rate of the rehydration rate calculated using the pediatric ten-fold rehydration formula was 97.69% (423/433), which was significantly higher than 0 (0/433) of the TWGB formula (χ²=826.90, P<0.05). Conclusions The application of the pediatric ten-fold rehydration formula to estimate the rehydration rate of pediatric patients after extensive burns is more accurate and convenient, superior to the TWGB formula, suitable for application by front-line healthcare workers that are not specialized in burns in pre-admission rescue of pediatric patients with extensive burns, and is worthy of promotion.
- Child /
- Burns /
- Shock /
- First aid /
- Ten-fold rehydration formula
申传安：提出小儿十倍法补液公式并进行研究方法的设计、文章撰写、经费支持；刘馨竹：数据分析、文章撰写；谢晓烨、张博涵、李大伟、刘兆兴、袁华庚：数据采集、文章撰写

所有作者均声明不存在利益冲突

HTML全文

参考文献(23)

[1]	JeschkeMG,van BaarME,ChoudhryMA,et al.Burn injury[J].Nat Rev Dis Primers,2020,6(1):11.DOI: 10.1038/s41572-020-0145-5.
[2]	杨宗城. 烧伤治疗学[M]. 3版. 北京: 人民卫生出版社,2006.
[3]	RomanowskiKS,PalmieriTL.Pediatric burn resuscitation: past, present, and future[J/OL].Burns Trauma,2017,5:26[2022-12-20]. https://pubmed.ncbi.nlm.nih.gov/28879205/. DOI: 10.1186/s41038-017-0091-y.
[4]	PisanoC, FabiaR, ShiJ,et al. Variation in acute fluid resuscitation among pediatric burn centers [J]. Burns, 2021,47(3):545-550. DOI: 10.1016/j.burns.2020.04.013.
[5]	PeckM,JengJ,MoghazyA.Burn resuscitation in the austere environment[J].Crit Care Clin,2016,32(4):561-565.DOI: 10.1016/j.ccc.2016.06.010.
[6]	ChungKK,WolfSE,CancioLC,et al.Resuscitation of severely burned military casualties: fluid begets more fluid[J].J Trauma,2009,67(2):231-237; discussion 237.DOI: 10.1097/TA.0b013e3181ac68cf.
[7]	KearnsRD,ConlonKM,MatherlyAF,et al.Guidelines for burn care under austere conditions: introduction to burn disaster, airway and ventilator management, and fluid resuscitation[J].J Burn Care Res,2016,37(5):e427-e439.DOI: 10.1097/BCR.0000000000000304.
[8]	HughesA,AlmelandSK,LeclercT,et al.Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020[J].Burns,2021,47(2):349-370.DOI: 10.1016/j.burns.2020.07.001.
[9]	申传安. 危重烧伤救治新技术体系[M]. 北京:人民卫生出版社,2021:40-41.
[10]	BenickeM,PerbixW,LeferingR,et al.New multifactorial burn resuscitation formula offers superior predictive reliability in comparison to established algorithms[J].Burns,2009,35(1):30-35.DOI: 10.1016/j.burns.2008.06.006.
[11]	World Health OrganizationBurns2018-03-06https://www.who.int/en/news-room/fact-sheets/detail/burn World Health Organization.Burns[EB/OL].[2018-03-06].https://www.who.int/en/news-room/fact-sheets/detail/burn.
[12]	程文凤,赵东旭,申传安,等.14岁以下儿童大面积烧伤的多中心流行病学调查[J].中华医学杂志,2017,97(6):462-467.DOI: 10.3760/cma.j.issn.0376-2491.2017.06.013.
[13]	ArbuthnotMK,GarciaAV.Early resuscitation and management of severe pediatric burns[J].Semin Pediatr Surg,2019,28(1):73-78.DOI: 10.1053/j.sempedsurg.2019.01.013.
[14]	YakupuA,ZhangJ,DongW,et al.The epidemiological characteristic and trends of burns globally[J].BMC Public Health,2022,22(1):1596.DOI: 10.1186/s12889-022-13887-2.
[15]	GillenwaterJ,GarnerW.Acute fluid management of large burns: pathophysiology, monitoring, and resuscitation[J].Clin Plast Surg,2017,44(3):495-503.DOI: 10.1016/j.cps.2017.02.008.
[16]	KangD,YooKY.Fluid management in perioperative and critically ill patients[J].Acute Crit Care,2019,34(4):235-245.DOI: 10.4266/acc.2019.00717.
[17]	ClarkA,NeyraJA,MadniT,et al.Acute kidney injury after burn[J].Burns,2017,43(5):898-908.DOI: 10.1016/j.burns.2017.01.023.
[18]	SuK,XueFS,XueZJ,et al.Clinical characteristics and risk factors of early acute kidney injury in severely burned patients[J].Burns,2021,47(2):498-499.DOI: 10.1016/j.burns.2020.08.018.
[19]	郭振荣.烧伤休克期补液[J].中华烧伤杂志,2008,24(5):328-330.DOI: 10.3760/cma.j.issn.1009-2587.2008.05.004.
[20]	JeschkeMG,HerndonDN.Burns in children: standard and new treatments[J].Lancet,2014,383(9923):1168-1178.DOI: 10.1016/S0140-6736(13)61093-4.
[21]	StrobelAM,FeyR.Emergency care of pediatric burns[J].Emerg Med Clin North Am,2018,36(2):441-458.DOI: 10.1016/j.emc.2017.12.011.
[22]	AhujaRB,BhattacharyaS.An analysis of 11,196 burn admissions and evaluation of conservative management techniques[J].Burns,2002,28(6):555-561.DOI: 10.1016/s0305-4179(02)00069-4.
[23]	LVKY,XiaZF, ZhangLM,et al.Epidemiology of pediatric burns requiring hospitalization in China: a literature review of retrospective studies[J].Pediatrics,2008,122(1):132-142.DOI: 10.1542/peds.2007-1567.