限制性液体管理策略防治严重烧伤早期肺脏并发症的临床研究

发布时间：2018-05-15 05:08

本文选题：严重烧伤 + 限制性液体管理策略　；参考：《第三军医大学学报》2017年08期

【摘要】：目的探讨限制性液体管理策略(restrictive fluid management strategy,RFMS)对严重烧伤早期肺脏并发症的防治作用。方法收集2012年6月至2014年12月入住西南医院烧伤科的严重烧伤患者32例作为对照组,收集2015年1月至2016年7月入住西南医院烧伤科的严重烧伤患者29例作为限制组。采用非随机前瞻性观察研究法分析:两组休克期(伤后2 d内)治疗方法相同,回吸收期(伤后3~10 d)对照组常规治疗,限制组实施RFMS,即适当控制补液总量+通过利尿促进体液排出。采用脉搏轮廓持续心输出量(pulseindicator continuous cardiac output,Pi CCO)容量监护仪监测并记录两组患者伤后10 d内血流动力学指标;记录伤后10 d每日液体入/出量并计算液体净平衡;记录实验室生化检查、病原菌培养结果;统计回吸收期呼吸机使用情况;分析患者伤后2周内急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)、肺部感染发生率。结果限制组回吸收期每日液体净平衡和每日累积液体净平衡均低于对照组。限制组回吸收期全心舒张末期容积指数(global end-diastolic volume index,GEDI)在各时间点上均低于对照组,对照组在伤后7d达正常值上限且持续在高水平维持,限制组于伤后7 d达峰值,此后呈下降趋势。对照组回吸收期血管外肺水指数(external venous lung water index,ELWI)均高于正常值上限,限制组仅在伤后7~9 d高于正常值上限。对照组和限制组回吸收期出现ELWI异常总天数的百分比分别为52.34%和35.34%,二者比较差异具有统计学意义(P0.01)。回吸收期对照组15例使用呼吸机,限制组6例,差异具有统计学意义(P0.05)。回吸收期呼吸机使用总天数的百分比分别为对照组41.02%,限制组18.53%,二者差异有统计学意义(P0.01)。两组患者伤后2周内对照组12例发生ARDS,限制组4例;对照组14例发生肺部感染,限制组5例;二者比较差异均有统计学意义(P0.05)。两组患者回吸收期心脏指数(CI)均高于正常值上限,平均动脉压(MAP)处于正常值范围。结论适当的RFMS可有效减少严重烧伤回吸收期液体净平衡,促进体液回吸收和减轻容量负荷,对预防和减轻早期严重烧伤肺水肿与肺部并发症具有重要作用。
[Abstract]:Objective to investigate the preventive and therapeutic effects of restrictive fluid management strategy (RFMS) on early lung complications in severe burn patients. Methods from June 2012 to December 2014, 32 severely burned patients admitted to the Department of Burn and Trauma in Southwest Hospital as control group, and 29 severely burned patients admitted to the Department of Burn from January 2015 to July 2016 as restriction group. Non-randomized prospective observation study was used to analyze: the two groups had the same treatment methods in shock phase (within 2 days after injury), and the control group in the reabsorption stage (3 days after injury) as control group. RFMS was implemented in the restricted group, that is, the total amount of fluid rehydration was controlled properly to promote the excretion of body fluid through diuretics. The pulse contour output continuous cardiac output Pi CCO volume monitor was used to monitor and record the hemodynamic indexes of the two groups within 10 days after injury, the daily fluid inflow / outflow volume was recorded 10 days after injury and the net liquid balance was calculated, and the laboratory biochemical examination was recorded. The results of pathogen culture, the use of ventilator during the reabsorption period, and the incidence of pulmonary infection were analyzed in patients with acute respiratory distress syndrome (ARDS) and acute respiratory distress syndrome (ARDS) within 2 weeks after injury. Results the daily liquid net equilibrium and the daily cumulative liquid net equilibrium in the reabsorption period of the control group were lower than those in the control group. The global end-diastolic volume index (end-diastolic volume) was lower in the control group than that in the control group at each time point. The control group reached the upper limit of the normal value on the 7th day after injury and maintained at the high level. The peak value of the control group reached the peak at the 7th day after injury, and then it showed a downward trend. In the control group, the extravascular pulmonary water index (venous lung water) was higher than the upper limit of the normal value, and that in the control group was higher than that in the control group only 7 days after injury. The percentage of total days of abnormal ELWI in the control group and the restricted group was 52.34% and 35.34% respectively. The difference between the two groups was statistically significant (P 0.01). In the reabsorption period, 15 cases in the control group were treated with ventilator, 6 cases in the restricted group, the difference was statistically significant (P 0.05). The percentage of the total days of ventilator use in the reabsorption period was 41.02 in the control group and 18.53 in the restriction group. The difference between the two groups was statistically significant (P 0.01). ARDS was found in 12 cases in the control group (4 cases) and pulmonary infection in 14 cases (5 cases) in the control group within 2 weeks after injury. The difference between the two groups was statistically significant (P 0.05). The cardiac index (CI) of both groups was higher than the upper limit of the normal value, and the mean arterial pressure (MAPP) was in the normal range. Conclusion proper RFMS can effectively reduce the liquid balance, promote the reabsorption of body fluid and lighten the volume load, and play an important role in preventing and alleviating pulmonary edema and pulmonary complications in early severe burn.
【作者单位】：第三军医大学护理学院;第三军医大学全军烧伤研究所创伤、烧伤与复合伤国家重点实验室;
【基金】：国家自然科学基金面上项目(81171810) 全军后勤科研“十二五”计划重点项目(BWS11J039) 重庆市社会民生科技创新专项(CSTC2015shmszx0656)~~
【分类号】：R473.6

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