摘要
目的探讨红细胞比容在烧伤休克早期诊断及液体复苏疗效评估中的临床意义。方法回顾性分析笔者单位2000年1月-2011年12月收治的131例特重度烧伤患者的临床资料，根据伤后第1个24h末红细胞比容水平将患者分为A组（80例）和B组（51例）。A组患者在伤后第1个24h末红细胞比容小于或等于0．50，B组患昔伤后第1个24h末红细胞比容大于0．50。2组患者在年龄、性别、体质量、伤后人院时间、烧伤总面积、Ⅲ度烧伤面积、吸人性损伤程度方面水平接近。记录患者休克期红细胞比容水平，记录伤后第1个24h患者尿量、剩余碱的水平及补液系数；计算患者并发症发生率及病死率。对数据进行t检验、x2检验或Wilcoxon秩和检验。结果伤后第1个24h末，A组患者红细胞比容降至约0．45，B组患者红细胞比容降至约0．55。A组患者伤后第1个24h尿量为（61±22）mL／h，明显多于B组[（53±20）mL／h，t=2．212，P〈0．05]；A组患者伤后第1个24h剩余碱为（-6．1±2．9）mmol／L，明显高于B组[（-9．0±3．8）mmol／[t=4．888，P〈0．01]；A组患者伤后第1个24h补液系数为（1．9±0．4）mL·kg·％‘FBSA-1，明显大于B组[（1．7±0．4）mL·kg-1％TBSA-1，t=2．472，P〈0．05]。A组患眷伤后并发症发生率及病死率分别为11．3％（9／80）、8．8％（7／80），明显低于B组[27．5％（14／51）、21．6％（11／51），x2值分别为5．648、4．318，P值均小于0．05]。结论红细胞比容能间接反映烧伤休克期复苏效果。伤后第1个241，内红细胞比容能否降至0．45～0．50，可作为评估特重度烧伤休克早期复苏是否满意的重要指标。
Objective To explore the clinieal significance of hematoerit used as a predictor for diagnosis and evaluation of resuscitation effcet in the early shock stage after burn. Methods Clinical data of 131 severely burned patients admitted to our burn unit from January 2000 to December 2011 were retrospeetively analyzed. The burn patients were divided into group A （ n = 80） and group B （ n = 51 ） based on the hematoerit level at post burn hour （PBH） 24. The hematocrit levels in group A wcrc less than or equal to 0.50, whieh in group B were higher＇ than 0.50. There were no statistically significant differences between two groups in age, gender, body weight, admission time after burn, total burn area, full-thickness burn area, and degree of inhalation injury （ P values all above 0.05）. Hematocrit levels in the shock stage were recorded. Total urine output, base excess, and the volume of fluid infused per kg per % TBSA at PBH 24 were recorded. Rates of eomplieation and mortality were recorded. Data were processed with t test, chisquare test, and Wileoxon rank sum test. Results Hematocrit level of group A at PBH 24 was decreased to about O. 45, while that of group B was decreased to about 0.55. The urine output in group A at PBH 24 [（61±22） ml,/hl was higher than that in group B [ （53 ±20） mL/h, t --2. 212,P 〈0.05]. Base excess in group A at PBH 24 [ （ -6.1±2.9） mmol/l,] was significantly higher than that in group B [ （ -9.0 ± 3.8） retool/L, t = 4. 888, P 〈 0.01 ）. The volu,ne infused per kg per % TBSA was higher in group A[（1.9±0.4） mL ~ kg %TBSA-1 than in group B [（1.7 ＋0.4） mL .kg-1 %TBSA-1, t = 2. 472, P 〈 0.05 ]. The rates of complication and mortality in group A [ 11.3% （9/80） , 8.8% （7/80） , respectively] were significantly lower than those in group B [27.5% （ 14/51 ） , 21.6% （ 11/51 ） , withX 2 values respectively 5. 648 and 4. 318, P values all below 0.05 ]. Conclusions Hematocrit can indirectly reflect resuscitation effect in the burn shock stage. Whether hematocrit level can be lowered to 0.45-0.50 during the first 24 hours after burn may be an important index for evaluation of fluid resuscitation effect in the early shock stage after severe burn.
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2013年第3期235-238,共4页
Chinese Journal of Burns
基金
全军医学科技“十二五”科研重大项目（AWS11J008）
卫生部卫生行业科研专项（201202002）
