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Volume 37 Issue 10
Oct.  2021
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2021  >  37(10): 929-936
Yang M,Dai XH,Guo GH,et al.Fluid resusstrategy and efficacy evaluation in shock stage in severely burned children with different burn areas in different age groups[J].Chin J Burns,2021,37(10):929-936.DOI: 10.3760/cma.j.cn501120-20210408-00119.
Citation: Yang M,Dai XH,Guo GH,et al.Fluid resusstrategy and efficacy evaluation in shock stage in severely burned children with different burn areas in different age groups[J].Chin J Burns,2021,37(10):929-936.DOI: 10.3760/cma.j.cn501120-20210408-00119.
shu

Fluid resuscitation strategy and efficacy evaluation in shock stage in severely burned children with different burn areas in different age groups

doi: 10.3760/cma.j.cn501120-20210408-00119

  • Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China

Funds:

Regional Science Foundation Project of National Natural Science Foundation of China 81760342, 81960352

More Information
  • Corresponding author: Guo Guanghua, Email: guogh2000@hotmail.com
  • Received Date: 2021-04-08
    Abstract
  •     Objective   To explore the fluid resuscitation strategy in shock stage in severely burned children with different burn areas in different age groups, and to evaluate the curative effect.    Methods   A retrospective cohort study was conducted. From January 2015 to June 2020, 235 children with severe and above burns who met the inclusion criteria were hospitalized in the First Affiliated Hospital of Nanchang University, including 150 males and 85 females, aged 3 months to 12 years. After admission, it was planned to rehydrate the children with electrolyte, colloid, and water according to the domestic rehydration formula for pediatric burn shock, and the rehydration volume and speed were adjusted according to the children's mental state, peripheral circulation, heart rate, blood pressure, and urine output, etc. The actual input volume and planned input volume of electrolyte, colloid, water, and total fluid of all the children were recorded during the 8 hours since fluid replacement and the first and second 24 hours after injury. According to urine output during the 8 hours since fluid replacement, all the children were divided into satisfactory urine output maintenance group (119 cases) with urine output ≥1 mL·kg-1·h-1 and unsatisfactory urine output maintenance group (116 cases) with urine output<1 mL·kg-1·h-1, and the electrolyte coefficient, colloid coefficient, and water coefficient of the children were calculated during the 8 hours since fluid replacement. According to the total burn area, children aged<3 80="" 155="" years="" and="" 3-12="" were="" divided="" into="" total="" body="" surface="" area="" group="">25%TBSA group, respectively. The electrolyte coefficient, colloid coefficient, water coefficient, and urine output of the children were calculated or counted during the first and second 24 hours after injury, and the non-invasive monitoring indicators of body temperature, heart rate, respiratory rate, and percutaneous arterial oxygen saturation and efficacy indicators of hematocrit, platelet count, hemoglobin, albumin, creatinine, and alanine aminotransferase (ALT) of the children were recorded 48 hours after injury. The prognosis and outcome indicators of all the children during the treatment were counted, including complications, cure, improvement and discharge, automatic discharge, and death. Data were statistically analyzed with independent sample or paired sample t test, Mann-Whitney U test, chi-square test, and Fisher's exact probability test.    Results   During the 8 hours since fluid replacement, the actual input volume of electrolyte of all the children was significantly more than the planned input volume, and the actual input volumes of colloid, water, and total fluid were significantly less than the planned input volumes (Z=13.094, 5.096, 13.256, 7.742, P<0.01). During the first and second 24 hours after injury, the actual input volumes of electrolyte of all the children were significantly more than the planned input volumes, and the actual input volumes of water and total fluid were significantly less than the planned input volumes (Z=13.288, -13.252, 3.867, 13.183, -13.191, 10.091, P<0.01), while the actual input volumes of colloid were close to the planned input volumes (P>0.05). During the 8 hours since fluid replacement, compared with those in unsatisfactory urine output maintenance group, there was no significant change in electrolyte coefficient or colloid coefficient of children in satisfactory urine output maintenance group (P>0.05), while the water coefficient was significantly increased (Z=2.574, P<0.05). Among children <3 years="" compared="" with="" those="" in="">25%TBSA group, the electrolyte coefficient and water coefficient of children were significantly increased and the urine output of children was significantly decreased in 15%-25%TBSA group during the first and second 24 hours after injury (Z=-3.867, -6.993, -3.417, -5.396, -5.062, 1.503, P<0.05 or P<0.01), while the colloid coefficient did not change significantly (P>0.05); the levels of efficacy indicators of hematocrit, platelet count, and hemoglobin at 48 h after injury were significantly increased, while ALT level was significantly decreased (Z=-2.720, -3.099, -2.063, -2.481, P<0.05 or P<0.01); the levels of the rest of the efficacy indicators and non-invasive monitoring indicators at 48 h after injury did not change significantly (P>0.05). Among children aged 3-12 years, compared with those in >25%TBSA group, the electrolyte coefficient and water coefficient of children in 15%-25%TBSA group were significantly increased during the first and second 24 hours after injury, the colloid coefficient during the second 24 h was significantly decreased (Z=-2.042, -4.884, -2.297, -3.448, -2.480, P<0.05 or P<0.01), while the colloid coefficient during the first 24 hours after injury, urine output during the first and second 24 hours after injury, and the non-invasive monitoring indicators and efficacy indicators at 48 hours after injury did not change significantly (P>0.05). Complications occurred in 17 children during the treatment. Among the 235 children, 211 cases were cured, accounting for 89.79%, 5 cases were improved and discharged, accounting for 2.13%, 16 cases were discharged automatically, accounting for 6.81%, and 3 cases died, accounting for 1.28%.    Conclusions   The electrolyte volume in early fluid resuscitation in severely burned children exceeding the volume calculated by the formula can obtain a good therapeutic effect. Among children<3 years old, the volume of fluid resuscitation should be appropriately increased in children with extremely severe burns compared with children with severe burns during fluid resuscitation; among children aged 3-12 years, the colloid volume should be appropriately increased in children with extremely severe burns compared with children with severe burns during fluid resuscitation; non-invasive monitoring indicators can be used to monitor hemodynamics and guide fluid resuscitation in severely burned children.

     

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    • References(14)
  • [1]
    林国安. 小儿烧伤流行特点和早期处理[J/CD]. 中华损伤与修复杂志:电子版, 2018,13(4):247-252. DOI: 10.3877/cma.j.issn.1673-9450.2018.04.002.
    [2]
    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.
    [3]
    黎鳌. 黎鳌烧伤学[M]. 上海: 上海科学技术出版社, 2001: 828.
    [4]
    柴家科. 实用烧伤外科学[M]. 北京: 人民军医出版社, 2014.
    [5]
    中华医学会儿科学分会急救学组,中华医学会急诊医学分会儿科学组,中国医师协会儿童重症医师分会.儿童脓毒性休克(感染性休克)诊治专家共识(2015版)[J].中国小儿急救医学,2015,22(11):739-743.DOI: 10.3760/cma.j.issn.1673-4912.2015.11.001.
    [6]
    赖青鸿,张友来,辛国华.烧伤早期创面加深机制与防治措施的研究进展[J].中华烧伤杂志,2019,35(3):229-232.DOI: 10.3760/cma.j.issn.1009-2587.2019.03.014.
    [7]
    苏海涛,朱应来,李宗瑜,等.150例重度和特重度烧伤患儿休克期计划液体复苏的效果分析[J].中华烧伤杂志,2017,33(7):419-421.DOI: 10.3760/cma.j.issn.1009-2587.2017.07.005.
    [8]
    BAJrPruitt,ADJrMason,MoncriefJA.Hemodynamic changes in the early postburn patient: the influence of fluid administration and of a vasodilator (hydralazine)[J].J Trauma,1971,11(1):36-46.DOI: 10.1097/00005373-197101000-00003.
    [9]
    SaffleJR.Fluid creep and over-resuscitation[J].Crit Care Clin,2016,32(4):587-598.DOI: 10.1016/j.ccc.2016.06.007.
    [10]
    李宗瑜,吕茁.小儿烧伤救治相关问题的探讨[J].中华烧伤杂志,2017,33(7):401-403.DOI: 10.3760/cma.j.issn.1009-2587.2017.07.001.
    [11]
    曾庆玲,王庆梅,黎宁,等.尿量监测应用于烧伤休克防治的研究进展[J].中华烧伤杂志,2018,34(1):29-31.DOI: 10.3760/cma.j.issn.1009-2587.2018.01.006.
    [12]
    余惠,朱飘飘,陈丽映,等.脉搏轮廓心输出量监测技术在严重烧伤患者休克期液体复苏中的应用[J].中华烧伤杂志,2021,37(2):136-142.DOI: 10.3760/cma.j.cn501120-20200908-00403.
    [13]
    DavenportLM,DobsonGP,LetsonHL.The role of invasive monitoring in the resuscitation of major burns: a systematic review and meta-analysis[J].Int J Burns Trauma,2019,9(2):28-40.
    [14]
    TapkingC,PoppD,HerndonDN,et al.Cardiac dysfunction in severely burned patients: current understanding of etiology, pathophysiology, and treatment[J].Shock,2020,53(6):669-678.DOI: 10.1097/SHK.0000000000001465.
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