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严重烧伤创伤后的功能 - 减少复苏液体体积和改变液体强度的影响
Rolf K Gigengack1, Annemieke Dijkstra2, Berry I Cleffken3
1Departments of Trauma and Burn Surgery, Maasstad Hospital, Maasstadweg 21, Rotterdam 3079 DZ, the Netherlands; Amsterdam UMC, Amsterdam, Department of Intensive Care, De Boelelaan 1117, Amsterdam 1081HV, the Netherlands; Amsterdam UMC, Amsterdam, Department of Anesthesiology, De Boelelaan 1117, Amsterdam 1081HV, the Netherlands.
Burns : journal of the International Society for Burn Injuries
|August 19, 2025
概括
在严重烧伤创伤后,减少初始液体复苏体积和切换到同位素溶液并没有对功能产生不利影响. 这种协议的变化没有对烧伤患者的脏结果产生负面影响.
科学领域:
- 烧伤创伤管理管理
- 维护功能 维护功能
- 流体复苏策略 流体复苏策略
背景情况:
- 严重的烧伤创伤显著影响功能,增加患病率和死亡率.
- 最佳的液体复苏对于预防低血压或高血压和保持功能至关重要.
- 荷兰烧伤协会在2018年修订了其指导方针,改变了液体复苏协议.
研究的目的:
- 分析修订后的液体复苏方案对严重烧伤创伤患者功能的影响.
- 为了比较4mL/kg/TBSA的高性溶液与3mL/kg/TBSA的同性溶液的结果.
- 评估对膜过率,血肌素,尿液输出,AKI发生率和RRT需要的影响.
主要方法:
- 追溯,单中心,队列研究,包括15%以上的烧伤TBSA的成年患者.
- 包含期:协议修改前2.5年和修改后2.5年.
- 两种液体复苏方案的比较:4mL/kg/TBSA高性与3mL/kg/TBSA同性溶液.
主要成果:
- 包括108名患者 (52名在高压组,56名在同位素组),中位燃烧TBSA22%.
- 没有观察到功能 (GFR,肌素,尿液输出),AKI发病率或需要替代疗法的显著差异.
- 这两组人群的死亡率也相似.
结论:
- 减少最初的液体复苏量从4到3毫升/千克/TBSA,并切换到同位素溶液对于严重烧伤后的功能是安全的.
- 对于严重烧伤创伤的最佳液体复苏仍然是一个复杂的挑战.
- 需要个性化策略来优化烧伤患者的液体复苏.
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