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导向性限制性液体管理策略对严重烧伤合并重度吸入性损伤患者的影响 被引量:12

Influence of directed restrictive fluid management strategy on patients with serious burns complicated by severe inhalation injury
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摘要 目的探讨导向性限制性液体管理策略(RFMS)对严重烧伤合并重度吸入性损伤患者的影响。方法将笔者单位2014年12月—2017年12月收治的16例符合入选标准且行RFMS的严重烧伤合并重度吸入性损伤患者作为导向治疗组;将笔者单位2012年12月—2017年12月收治的34例符合入选标准但未行RFMS的严重烧伤合并重度吸入性损伤患者作为常规治疗组,回顾性分析2组患者的病历资料。伤后2d内,导向治疗组采用脉搏轮廓心排血量监测技术监测平均动脉压(MAP)、中心静脉压(CVP)、血管外肺水指数(ELWI)、全心舒张末期容积指数、肺血管通透性指数,常规治疗组患者采用常规方法监测MAP、CVP。伤后3~7d,2组患者均按笔者单位常规方法进行补液治疗,维持血流动力学稳定,导向治疗组患者另以ELWI≤7mL·kg^-1·m^-2为液体治疗导向指标实施限制性液体管理策略(RFMS)。伤后3~7d,记录2组患者24h总入量、总出量、总入出量差,血乳酸值及氧合指数;统计伤后3~7d、伤后8~28d急性呼吸窘迫综合征(ARDS)的发生情况及伤后28d内机械通气时间、病死情况。对数据行χ2检验、t检验及重复测量方差分析。结果伤后3、4、5、6、7d,导向治疗组患者的24h总入量与常规治疗组相近(t=-0.835、-1.618、-2.463、-1.244、-2.552,P>0.05)。伤后3d,2组患者24h总出量、总入出量差相近(t=0.931、-2.274,P>0.05)。伤后4、5、6、7d,导向治疗组患者24h总出量明显高于常规治疗组(t=2.645、2.352、1.847、1.152,P<0.05)。伤后4、5、6、7d,导向治疗组患者24h总入出量差为(2928±768)、(2028±1001)、(2186±815)、(2071±963)mL,明显低于常规治疗组(4455±960)、(3434±819)、(3233±1022)、(3453±829)mL,t=-4.331、-3.882、-3.211、-4.024,P<0.05。伤后3、4、5、6、7d,导向治疗组患者血乳酸值与常规治疗组相近(t=0.847、1.221、0.994、1.873、1.948,P>0.05)。伤后3、4d,导向治疗组患者氧合指数为(298±78)、(324± Objective To explore the influence of directed restrictive fluid management strategy(RFMS)on patients with serious burns complicated by severe inhalation injury.Methods Sixteen patients with serious burns complicated by severe inhalation injury hospitalized in our department from December 2014 to December 2017,meeting the inclusion criteria and treated with RFMS,were enrolled in directed treatment group.Thirty-four patients with serious burns complicated by severe inhalation injury hospitalized in our department from December 2012 to December 2017,meeting the inclusion criteria and without RFMS,were enrolled in routine treatment group.Medical records of patients in 2 groups were retrospectively analyzed.Within post injury day 2,mean arterial pressure(MAP),central venous pressure(CVP),extravascular lung water index(ELWI),global end-diastolic volume index,and pulmonary vascular permeability index of patients in directed treatment group were monitored by pulse contour cardiac output monitoring technology,while MAP and CVP of patients in routine treatment group were monitored by routine method.On post injury day 3 to 7,patients in 2 groups were treated with routine fluid supplement therapy of our Department to maintain hemodynamic stability,and patients in directed treatment group were treated according to RFMS directed with goal of ELWI≤7 mL·kg^-1·m^-2.On post injury day 3 to 7,total fluid intake,total fluid output,and total fluid difference between fluid intake and output within 24 h,value of blood lactic acid,and oxygenation index of patients in 2 groups were recorded.Occurrence of acute respiratory distress syndrome(ARDS)on post injury day 3 to 7 and 8 to 28,mechanical ventilation time within post injury day 28,and occurrence of death of patients in 2 groups were counted.Data were processed with chi-square test,t test,and analysis of variance for repeated measurement.Results The total fluid intakes within 24 h of patients in directed treatment group were close to those in routine treatment group on post injur
作者 王志勇 冯世海 范宝莉 谢宇钢 马伟 贾享成 耿辉 Wang Zhiyong;Feng Shihai;Fan Baoli;Xie Yugang;Ma Wei;Jia Xiangcheng;Geng Hui(Department of Burns and Plastic Surgery,Affiliated Hospital of Nankai University (the Fourth Hospital of Tianjin),Tianjing 300222 ,China)
出处 《中华烧伤杂志》 CAS CSCD 北大核心 2019年第7期501-506,共6页 Chinese Journal of Burns
关键词 烧伤 补液疗法 烧伤 吸入性 血管外肺水指数 导向性液体管理 Burns Fluid therapy Burns,inhalation Extravascular lung water index Directed fluid management
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