CAJ | 학술논문

目的探讨特重度烧伤患者切痂植皮术中控制性降压的适宜程度.方法拟行切痂植皮术的特重度烧伤患者30例,年龄18 ～ 54岁,性别不限,体重56 ～ 75 kg,ASA分级Ⅲ或Ⅳ级,烧伤总面积70％～ 95％,Ⅲ度烧伤面积50％～ 75％,术中切痂面积28％～ 33％,采用随机数字表法,将患者分为3组(n=10):对照组(C组)和不同程度控制性降压组(CH1,2组).C组不行控制性降压,维持MAP 80 ～ 90 mmHg; CH1,2组静脉输注硝酸甘油0.2～ 0.8 μg·kg-1·min-进行控制性降压,CH1组MAP降低幅度为基础值的10％,CH2组MAP降低幅度为基础值的20％.于术前30 min(T1)和术毕(T2)时测定血清肌酐(Cr)、尿素氮(BUN)浓度,尿β2-微球蛋白(β2-MG)和尿微量白蛋白(mALB)浓度.记录术中失血量及尿量.术后24h内记录急性肾损伤的发生情况及程度.结果与C组比较,CH1组和CH2组术中失血量减少,CH2组尿量减少,T2时血清Cr浓度、尿β2-MG和mALB浓度升高(P＜0.05),CH1组肾功能各指标差异无统计学意义(P＞0.05);与CH1组比较,CH2组T2时血清Cr浓度、尿β2-MG和mALB浓度升高(P＜0.05),术中失血量、尿量差异无统计学意义(P＞0.05).C组和CH1组术后未见急性肾损伤发生,CH2组急性肾损伤发生率为40％,均为Ⅰ期.结论 MAP降低幅度为基础值的10％是特重度烧伤患者切痂植皮术中控制性降压的适宜程度.
목적 탐토특중도소상환자절가식피술중공제성강압적괄의정도.방법 의행절가식피술적특중도소상환자30례,년령18 ～ 54세,성별불한,체중56 ～ 75 kg,ASA분급Ⅲ혹Ⅳ급,소상총면적70％～ 95％,Ⅲ도소상면적50％～ 75％,술중절가면적28％～ 33％,채용수궤수자표법,장환자분위3조(n=10):대조조(C조)화불동정도공제성강압조(CH1,2조).C조불행공제성강압,유지MAP 80 ～ 90 mmHg; CH1,2조정맥수주초산감유0.2～ 0.8 μg·kg-1·min-진행공제성강압,CH1조MAP강저폭도위기출치적10％,CH2조MAP강저폭도위기출치적20％.우술전30 min(T1)화술필(T2)시측정혈청기항(Cr)、뇨소담(BUN)농도,뇨β2-미구단백(β2-MG)화뇨미량백단백(mALB)농도.기록술중실혈량급뇨량.술후24h내기록급성신손상적발생정황급정도.결과 여C조비교,CH1조화CH2조술중실혈량감소,CH2조뇨량감소,T2시혈청Cr농도、뇨β2-MG화mALB농도승고(P＜0.05),CH1조신공능각지표차이무통계학의의(P＞0.05);여CH1조비교,CH2조T2시혈청Cr농도、뇨β2-MG화mALB농도승고(P＜0.05),술중실혈량、뇨량차이무통계학의의(P＞0.05).C조화CH1조술후미견급성신손상발생,CH2조급성신손상발생솔위40％,균위Ⅰ기.결론 MAP강저폭도위기출치적10％시특중도소상환자절가식피술중공제성강압적괄의정도.
Objective To investigate the optimum degree of controlled hypotension during eschar excision and skin grafting in the patients with extremely severe bum.Methods Thirty patients with extremely severe burn,aged 18-54 yr,weighing 56-75 kg,of ASA physical status Ⅲ or Ⅳ,with total burn covering 70％-95％ of total body surface area,a third-degree burn covering 50％-75％ of total body surface area,and excision covering 28％-33％ of total body surface area,scheduled for elective eschar excision and skin grafting,were randomly divided into3 groups (n =10 each) using a random number table:control group (group C) and different degrees of controlled hypotension groups (CH1.2 groups).In group C,controlled hypotension was not performed,and mean arterial pressure (MAP) was maintained at 80-90 mmHg.Controlled hypotension was induced with continuous iv infusion of nitroglycerin at a rate of 0.2-0.8 μg· kg-1· min-1.MAP decreased by 10％ of baseline value in group CH1 and by 20％ of baseline value in group CH2.At 30 min before surgery and the end of surgery,serum creatinine (Cr),blood urea nitrogen (BUN),urinary β2-microglobulin (β2-MG) and microalbumin (mALB) concentrations were detected.The volume of blood loss and urine volume were recorded during surgery.Acute renal injury was recorded within 24 after surgery and graded.Results Compared with group C,the volume of blood loss during surgery was significantly reduced in CH1 and CH2 groups,urine volume was reduced,and serum Cr,urinary β2-MG and mALB concentrations were increased at T2 in CH2 group,and no significant change was found in each parameter of renal function in group CH1.Compared with group CH1,the serum Cr,urinary β2-MG and mALB concentrations were increased at T2,and no significant change was found in the volume of blood loss and urine volume during surgery in CH2 group.No patients developed acute renal injury after surgery in C and CH1 groups,and the incidence of acute renal injury was 40％ and all were in stage Ⅰ in CH2 group.Conclusion MAP decreasing by 10％ of baseline value is the optimum degree of controlled hypotension during eschar excision and skin grafting in the patients with extremely severe burn.