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

左风利; 任辉; 张家平

doi:10.16016/j.1000-5404.201610090

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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

临床医学 | 更新时间：2026-01-09

- 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
- A restrictive fluid management strategy for prevention of pulmonary complications early after severe burns: a report of 29 cases
- 第三军医大学学报 2017年39卷第8期页码：794-800
- 作者机构：
- 作者简介：
- 基金信息：
  
  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(CSTC 2015shmszx0656)
- DOI：10.16016/j.1000-5404.201610090
  中图分类号：
- 纸质出版：2017-04
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左风利, 任辉, 张家平. 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[J]. 第三军医大学学报, 2017,39(8):794-800.

Fengli Zuo, Hui Ren, Jiaping Zhang. A restrictive fluid management strategy for prevention of pulmonary complications early after severe burns: a report of 29 cases[J]. Journal of Third Military Medical University, 2017, 39(8): 794-800.
左风利, 任辉, 张家平. 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[J]. 第三军医大学学报, 2017,39(8):794-800. DOI： 10.16016/j.1000-5404.201610090.

Fengli Zuo, Hui Ren, Jiaping Zhang. A restrictive fluid management strategy for prevention of pulmonary complications early after severe burns: a report of 29 cases[J]. Journal of Third Military Medical University, 2017, 39(8): 794-800. DOI： 10.16016/j.1000-5404.201610090.

摘要

Abstract

Objective

To analyze the effect of a restrictive fluid management strategy (RFMS) for prevention pulmonary complications in patients during the early stages following severe burns.

Methods

With 32 patients suffering from severe burns admitted in Southwest Hospital between June 2012 and December 2014 as the control group

29 patients admitted between January 2015 and July 2016 were enrolled as the treatment group. Following identical treatment protocols within the initial 2 days

the control group and the treatment group received routine fluid therapy and RFMS-based treatment in 3~10 d postburn

respectively. Within 10 d postburn

the hemodynamic indexes of the 2 groups were monitored

and the fluid intake and output

daily fluid net balance

daily fluid cumulative net balance

results of laboratory test

pathogenic bacteria culture results and the use of ventilation were recorded. The incidences of acute respiratory distress syndrome (ARDS) and pulmonary infection within 2 weeks postburn were compared between the 2 groups.

Results

Both the daily fluid net balance and daily fluid cumulative net balance were lower in the treatment group than in the control group from 2 to 10 d postburn. The global end-diastolic volume index (GEDI) remained lower in the treatment group than in the control group from 2 to 10 d postburn

reaching the peak level on day 7 and still maintaining a high level afterwards in the control group; global end-diastolic uolume index (GEDI) peaked on day 7 in the treatment group and tended to decrease over time. The extravascular lung water index (ELWI) was above the normal level only from 7 to 9 d postburn in the treatment group

as compared with in 3 to 10 d in the control group; the percentage of the total days with abnormal ELWI since postburn day 2 was significantly greater in the control group (52.34%

35.34%

0.01). Six patients in the treatment group and 15 in the control group required assisted ventilation from 3 to 10 d postburn (

0.05)

with the percentages of total days with ventilation of 41.02% and 18.53% in the 2 groups

respectively (

0.01). Lung infection and ARDS occurred within 2 weeks postburn in 14 and 12 patients in the control group

and in 5 and 4 patients in treatment group

respectively (

0.05). In both the 2 groups

the cardiac index remained higher than normal but the mean arterial pressure was within the normal range from 3 to 10 d postburn.

Conclusion

Appropriate RFMS can effectively reduce fluid net balance in the fluid reabsorption stage following burn injury to promote body fluid resorption and reduce the load capacity

and thus is critical for preventing and ameliorating early pulmonary edema and pulmonary complications following severe burn injuries.

关键词

Keywords

references

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