中华损伤与修复杂志(电子版)
中華損傷與脩複雜誌(電子版)
중화손상여수복잡지(전자판)
Chinese Journal of Injury Repair and Wound Healing
2009年
2期
151-155
,共5页
邢溢庆%骆永红%徐琦%赵全%王玉莲
邢溢慶%駱永紅%徐琦%趙全%王玉蓮
형일경%락영홍%서기%조전%왕옥련
烧伤%休克期%代谢性碱中毒
燒傷%休剋期%代謝性堿中毒
소상%휴극기%대사성감중독
severe burns%shock stage%metabolic alkalosis
目的 了解重症烧伤休克期代谢性碱中毒(Metabolic alkalosis)的病因、治疗方法以及监测手段等相关因素,以预防其发生.方法 收集13例重症烧伤患者自入院至发生代谢性碱中毒发现时所有临床资料,从治疗措施、液体入量及种类、碱性药物、利尿剂、血管扩张剂的应用情况,以及代谢性碱中毒发现后钾入量和盐酸精氨酸的应用情况等方面,比较二氧化碳结合力与血气分析的临床敏感性.结果 13例患者休克期第1个24 h平均液体总入量达到(3.3 ±0.80)m1.kg-1·1%TBSA.其中乳酸钠林格氏液(5285±2003)ml,血浆为(3450±2498)ml:13例患者中,在伤后第一天发生代谢性碱中毒的6例患者,均于伤后短时间内应用5%碳酸氢钠125 ml~570 ml.13例患者休克期分别应用呋塞米、多巴胺、20%甘露醇、利尿,致第1个24 h尿量平均达到(125±49)ml.经对血气分析中BE、HCO3与血C02-CP同时相、同量标本数监测凝据比较,前两者均高于正常参考值,而后者均在正常参考值内.13例患者经积极处理原发病,适当补钾,静脉输入盐酸精氨酸等临床治疗,所有患者的代谢性碱中毒全部得到纠正.结论 重症烧伤休克期补液量应在有创和无创监测下平稳达到复苏指标,尿量以1 ml·kg-1·h-1为度.患者入院后即行血气分析监测,或可预警代谢性碱中毒的发生.
目的 瞭解重癥燒傷休剋期代謝性堿中毒(Metabolic alkalosis)的病因、治療方法以及鑑測手段等相關因素,以預防其髮生.方法 收集13例重癥燒傷患者自入院至髮生代謝性堿中毒髮現時所有臨床資料,從治療措施、液體入量及種類、堿性藥物、利尿劑、血管擴張劑的應用情況,以及代謝性堿中毒髮現後鉀入量和鹽痠精氨痠的應用情況等方麵,比較二氧化碳結閤力與血氣分析的臨床敏感性.結果 13例患者休剋期第1箇24 h平均液體總入量達到(3.3 ±0.80)m1.kg-1·1%TBSA.其中乳痠鈉林格氏液(5285±2003)ml,血漿為(3450±2498)ml:13例患者中,在傷後第一天髮生代謝性堿中毒的6例患者,均于傷後短時間內應用5%碳痠氫鈉125 ml~570 ml.13例患者休剋期分彆應用呋塞米、多巴胺、20%甘露醇、利尿,緻第1箇24 h尿量平均達到(125±49)ml.經對血氣分析中BE、HCO3與血C02-CP同時相、同量標本數鑑測凝據比較,前兩者均高于正常參攷值,而後者均在正常參攷值內.13例患者經積極處理原髮病,適噹補鉀,靜脈輸入鹽痠精氨痠等臨床治療,所有患者的代謝性堿中毒全部得到糾正.結論 重癥燒傷休剋期補液量應在有創和無創鑑測下平穩達到複囌指標,尿量以1 ml·kg-1·h-1為度.患者入院後即行血氣分析鑑測,或可預警代謝性堿中毒的髮生.
목적 료해중증소상휴극기대사성감중독(Metabolic alkalosis)적병인、치료방법이급감측수단등상관인소,이예방기발생.방법 수집13례중증소상환자자입원지발생대사성감중독발현시소유림상자료,종치료조시、액체입량급충류、감성약물、이뇨제、혈관확장제적응용정황,이급대사성감중독발현후갑입량화염산정안산적응용정황등방면,비교이양화탄결합력여혈기분석적림상민감성.결과 13례환자휴극기제1개24 h평균액체총입량체도(3.3 ±0.80)m1.kg-1·1%TBSA.기중유산납림격씨액(5285±2003)ml,혈장위(3450±2498)ml:13례환자중,재상후제일천발생대사성감중독적6례환자,균우상후단시간내응용5%탄산경납125 ml~570 ml.13례환자휴극기분별응용부새미、다파알、20%감로순、이뇨,치제1개24 h뇨량평균체도(125±49)ml.경대혈기분석중BE、HCO3여혈C02-CP동시상、동량표본수감측응거비교,전량자균고우정상삼고치,이후자균재정상삼고치내.13례환자경적겁처리원발병,괄당보갑,정맥수입염산정안산등림상치료,소유환자적대사성감중독전부득도규정.결론 중증소상휴극기보액량응재유창화무창감측하평은체도복소지표,뇨량이1 ml·kg-1·h-1위도.환자입원후즉행혈기분석감측,혹가예경대사성감중독적발생.
Objective To investigate cause,therapy and monitoring measures of severe burns with metabolic alkalosis so as to prevent metabolic alkalosis. Methods Therapy measures of 13 severe burns patients were studied from their admission to onset of metabolic alkalosis, including liquid amount and category, usage of alkaline drug, diuretic agent and vasodilator, dosage of potassium and arginine hydrochloride after metabolic alkalosis. The clinical sensitivity of carbon dioxide combining power and blood gas analysis were compared. Results The occurrence of metabolic alkalosis in 13 patients was due to generous fluid supplement in inhibitory stage of shock, usage of alkaline drugs and diuretic agent. Blood gas analysis was a more sensitive monitoring measure than carbon dioxide combining power on metabolic alkalosis. Conclusions Fluid supplement in shock stage should be controlled under invasive or non-invasive monitoring to achieve a smooth recovery. The level of urinary volume should be controlled up to 1 ml · kg-1 · h-1. Blood gas analysis should be monitored immediately after the wounded being delivered to hospital. Then metabolic alkalosis may be predicted.