限制性液体管理策略对严重烧伤患者早期肺功能影响的对比研究
한제성액체관리책략대엄중소상환자조기폐공능영향적대비연구
Comparative study on the effect of restrictive fluid management strategy on the early pulmonary function of patients with severe burn
  • 万方数据
    中华烧伤杂志 중화소상잡지
    16
    2012年 3期 165-169 ,共5页

    张家平%向飞%童大力%罗奇志%袁志强%颜洪%李晓鲁%陈建%彭代智%罗高兴%彭毅志%黄跃生%吴军

    장가평%향비%동대력%라기지%원지강%안홍%리효로%진건%팽대지%라고흥%팽의지%황약생%오군

    烧伤%水电解质平衡%肺水肿%肺氧合功能%限制性液体管理策略 燒傷%水電解質平衡%肺水腫%肺氧閤功能%限製性液體管理策略
    소상%수전해질평형%폐수종%폐양합공능%한제성액체관리책략
    Burns%Water-electrolyte balance%Pulmonary edema%Pulmonary oxygenation%Restrictive fluid management strategy
    目的 回顾性分析限制性液体管理策略(RFMS)对特重度大面积烧伤患者早期肺功能及其预后的影响. 方法 将笔者单位2010年6月-2011年11月收治的于体液回吸收期采用RFMS治疗的13例特重度烧伤患者设为治疗组,另将2008年3月-2011年11月收治的于体液回吸收期采用常规液体治疗的26例特重度烧伤患者设为对照组,2组按1∶2比例配对.记录并比较2组患者伤后3～10d液体总入量、总出量与入出量差值,以及血浆白蛋白水平；伤后3、5、7、10、14d肺氧合指数；伤后7～14d肺部和血液感染情况；伤后2周内急性呼吸窘迫综合征(ARDS)发生情况、其他脏器并发症发生情况和死亡情况.对计量资料行t检验和随机区组方差分析,计数资料行Fisher确切概率法检验. 结果 2组患者液体总入量伤后3～10d呈下降趋势.除伤后4d外,其余时相点2组液体总入量比较差异均无统计学意义(F值为0.072 ～1.939,P值均大于0.05).2组患者液体总出量伤后3～10d呈上升趋势,对照组于伤后10 d达峰值,治疗组于伤后6d达峰值.伤后4～9d,治疗组液体总出量大于对照组(F值为0.001 ～3.026,P值均大于0.05).2组患者液体入出量差值呈下降趋势,对照组于伤后10d达低谷,治疗组于伤后6d达低谷.伤后3～7d治疗组液体入出量差值低于对照组,其中伤后4～6d组间比较差异有统计学意义(F值为4.799 ～8.031,P值均小于0.05).伤后3～10d治疗组血浆白蛋白水平均高于对照组,其中伤后4、9、10 d组间比较差异有统计学意义(F值为5.691～10.551,P＜0.05或P＜0.01).伤后3～14d治疗组肺氧合指数均高于对照组,其中伤后7、14d治疗组(分别为372±78、354±39)明显高于对照组(分别为291±92、283±72,F值分别为5.184、8.683,P值均小于0.05).伤后7～14d治疗组患者中发生肺部和血液感染者分别为1、4例,少于对照组的9、11例.伤后2周内治疗组ARDS发生情况、其他脏器并发症发生情况和死亡情况均少于对照组,但差异均无统计学意义(P值均大于0.05). 结论 RFMS能加快特重度大面积烧伤患者体液回吸收和促进体液再平衡,显著改善患者早期肺氧合功能,对减少脏器并发症、提高严重烧伤救治存活率可能具有积极作用.
    목적 회고성분석한제성액체관리책략(RFMS)대특중도대면적소상환자조기폐공능급기예후적영향. 방법 장필자단위2010년6월-2011년11월수치적우체액회흡수기채용RFMS치료적13례특중도소상환자설위치료조,령장2008년3월-2011년11월수치적우체액회흡수기채용상규액체치료적26례특중도소상환자설위대조조,2조안1∶2비례배대.기록병비교2조환자상후3～10d액체총입량、총출량여입출량차치,이급혈장백단백수평；상후3、5、7、10、14d폐양합지수；상후7～14d폐부화혈액감염정황；상후2주내급성호흡군박종합정(ARDS)발생정황、기타장기병발증발생정황화사망정황.대계량자료행t검험화수궤구조방차분석,계수자료행Fisher학절개솔법검험. 결과 2조환자액체총입량상후3～10d정하강추세.제상후4d외,기여시상점2조액체총입량비교차이균무통계학의의(F치위0.072 ～1.939,P치균대우0.05).2조환자액체총출량상후3～10d정상승추세,대조조우상후10 d체봉치,치료조우상후6d체봉치.상후4～9d,치료조액체총출량대우대조조(F치위0.001 ～3.026,P치균대우0.05).2조환자액체입출량차치정하강추세,대조조우상후10d체저곡,치료조우상후6d체저곡.상후3～7d치료조액체입출량차치저우대조조,기중상후4～6d조간비교차이유통계학의의(F치위4.799 ～8.031,P치균소우0.05).상후3～10d치료조혈장백단백수평균고우대조조,기중상후4、9、10 d조간비교차이유통계학의의(F치위5.691～10.551,P＜0.05혹P＜0.01).상후3～14d치료조폐양합지수균고우대조조,기중상후7、14d치료조(분별위372±78、354±39)명현고우대조조(분별위291±92、283±72,F치분별위5.184、8.683,P치균소우0.05).상후7～14d치료조환자중발생폐부화혈액감염자분별위1、4례,소우대조조적9、11례.상후2주내치료조ARDS발생정황、기타장기병발증발생정황화사망정황균소우대조조,단차이균무통계학의의(P치균대우0.05). 결론 RFMS능가쾌특중도대면적소상환자체액회흡수화촉진체액재평형,현저개선환자조기폐양합공능,대감소장기병발증、제고엄중소상구치존활솔가능구유적겁작용.
    Objective To retrospectively analyze the effect of restrictive fluid management strategy (RFMS) on the early pulmonary function and the prognosis of patients with extremely severe and extensive burn. Methods Thirteen patients with extremely severe burn hospitalized from June 2010 to November 2011,being treated with RFMS in the fluid reabsorption stage,were enrolled as treatment group.Twenty-six patients with extremely severe burn hospitalized from March 2008 to November 2011,being treated with normal fluid therapy in the fluid reabsorption stage,were enrolled as control group.The match proportion between treatment group and control group was 1 ∶ 2.Fluid intake,fluid output,fluid balance ( the difference between fluid intake and output),and plasma albumin level from post burn day (PBD) 3 to 10,pulmonary oxygenation index on PBD 3,5,7,10,and 14,occurrence of lung and blood stream infections from PBD 7to 14,and occurrence of acute respiratory distress syndrome (ARDS),occurrence of other organ complications,and mortality within 2 weeks post burn (PBW) were recorded and compared.Measurement data were processed with t test and randomized blocks analysis of variance,enumeration data were processed with Fisher's exact test. Results Daily fluid intake of patients showed a tendency of decrease in both groups from PBD 3 to 10.Except for that of PBD4,there was no statistically significant difference between two groups in fluid intake ( with F values from 0.072 to 1.939,P values all above 0.05 ).Daily fluid output of patients showed a tendency of increase in both groups from PBD 3 to 10.It peaked on PBD 10 in control group and PBD 6 in treatment group.The mean daily fluid output was higher in treatment group than in control group from PBD 4 to 9,but without statistically significant difference ( with F values from 0.001 to 3.026,P values all above 0.05).Fluid balance lowered in both groups,and it was the lowest on PBD 10 in control group and PBD 6 in treatment group.Fluid balance was lower in treatment group than in control group from PBD 3 to 7,and it showed statistically significant differences on PBD 4,5,and 6 (with F values from 4.799 to 8.031,P values below 0.05 ).Plasma albumin level was higher in treatment group than in control group from PBD 3 to 10,with statistically significant differences observed on PBD 4,9,and 10 (with F values from 5.691 to 10.551,P ＜ 0.05 or P ＜ 0.01 ).Pulmonary oxygenation index was higher in treatment group than in control group from PBD 3 to 14,with statistically significant differences observed on PBD 7 ( respectively 372 ±78 in treatment group and 291 ±92 in control group,F =5.184,P ＜0.05) and 14 (respectively 354 ± 39 in treatment group and 283 ± 72 in control group,F =8.683,P ＜ 0.05).Lung infection and blood stream infection were respectively observed in 1 and 4 patient (s) in treatment group,and 9 and 11 patients in control group from PBD 7 to 14.Occurrence of ARDS,occurrence of other organ complications,and mortality were fewer in treatment group than in control group within PBW 2,though the differences were not statistically significant ( P values all above 0.05). Conclusions RFMS is a useful strategy in improving early pulmonary oxygenation of patients with extremely severe and extensive burn by promoting the process of fluid reabsorption and rebalance.This strategy may be also beneficial for the prevention of organ complications as well as a better prognosis in severely burned patients.
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