[Performing escharectomy following "clinical guidelines" in extensively burned patients during burn shock stage]

To verify the practicability of performing escharectomy on extensively burned patients during shock stage following the clinical guidelines only.

Sixty-five burn patients with total body surface area(TBSA) over 30% received resuscitation to prevent and treat burn shock without hemodynamic monitoring. Clinical indexes of optimal resuscitation, such as a urine volume 80 to 100 ml/h, heart rate around 100 to 110/min, respiration rate 20 to 24/min, significant alleviation of thirst, sense of nausea and vomiting, clear mentality, Hb < or = 150 g/l and Hct < or = 0.50 were adopted as guidelines, under which thirty-three patients underwent escharectomy and grafting during burn shock stage (group A). For comparison, other 32 patients received escharectomy 96 hr after injury(group B). The incidences of sepsis and MODS were analyzed. Plasma samples from 12 patients in group A and 9 patients in group B were assayed at interval for LPS, TNF, IL-6 and IL-8.

All 33 patients in group A were in stable condition, and the incidence of sepsis was lower (34.4%) than that in group B(56.3%). The incidence of MODS and the mortality of patients in group A was lower than those in group B. Levels of LPS, TNF, IL-6 and IL-8 in plasma were lower in group A as compared with those in group B.

The results show that escharectomy could be performed during shock stage under clinical guidelines with reasonable safety.