严重烧伤后复苏的更高初始公式意味着更高的24小时体积
Julie A Rizzo1,2, Elsa C Coates3, Maria L Serio-Melvin3
1Brooke Army Medical Center, Fort Sam, Houston, Texas, USA.
概括
较低的初始流体速率用于烧伤复苏,如2毫升/千克/TBSA,是安全有效的. 这种方法避免了冲击,并且不会增加烧伤患者的死亡率或并发症.
科学领域:
- 创伤外科 手术 创伤外科
- 烧伤护理 烧伤护理
- 复苏医学 复苏医学 复苏医学
背景情况:
- 标准的烧伤复苏使用基于患者体重和烧伤的总体表面积 (TBSA) 的公式.
- 初始液体输液率对复苏量和患者结果的影响需要进一步研究.
研究的目的:
- 评估不同初始液体复苏率对24小时液体体积和患者结果的影响.
- 在烧伤患者中比较各种液体复苏配方的疗效和安全性.
主要方法:
- 燃烧导航器 (BN) 数据库的分析,包括296名患有≥20%的TBSA和>40公斤体重的患者.
- 四个复苏臂的比较:2毫升/千克/TBSA,3毫升/千克/TBSA,4毫升/千克/TBSA,以及十的规则.
- 评估24小时液体总量和复苏相关结果,包括冲击发生率和7天死亡率.
主要成果:
- 较高的初始流体速率 (4毫升/千克/TBSA) 与较低的速率 (2毫升/千克/TBSA,3.9±1.4毫升/千克/TBSA) 相比,导致24小时流体量显著增加 (5.2±2.2毫升/千克/TBSA).
- 最低的初始率 (2毫升/千克/TBSA) 显示了12%的休克发病率,低于十项规则和3毫升/千克/TBSA组.
- 在所有研究手臂中,没有观察到七天死亡率的显著差异.
结论:
- 较高的初始液体复苏率增加了24小时的液体总给药量.
- 初始流体速率为2毫升/千克/TBSA,是烧伤患者的安全复苏策略,与死亡率或并发症的增加无关.
- 选择最初的流体速率会影响复苏量,但不一定会影响患者的死亡率或并发症.
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