摘要
目的探讨重症烧伤患者烧伤休克早期使用人血白蛋白的治疗效果。方法选择宁夏医科大学附属石嘴山市第一人民医院烧伤整形科自2019年1月至2021年10月收治的重症烧伤患者77例为研究对象,采用随机数字表法将患者随机分成试验组和对照组,试验组41例,对照组36例。患者入院后均行抗感染治疗,保护各脏器功能,监测患者的各项生理指标,银离子敷料包扎创面等处理。试验组患者烧伤后第1个24 h输入胶体液量的50%使用羟乙基淀粉130/0.4氯化钠溶液和新鲜冰冻血浆于烧伤后8 h内输注,剩余50%胶体液量在烧伤后16 h内输注,人血白蛋白液于烧伤12 h后进行输注;烧伤后第2个24 h的胶体液量使用新鲜冰冻血浆+人血白蛋白液输注;烧伤后第3、4个24 h根据血常规和生化检查补充人血白蛋白液。对照组患者烧伤后第1个24 h输入胶体液量的50%使用羟乙基淀粉130/0.4氯化钠溶液500 mL和新鲜冰冻血浆于烧伤后8 h内输注,剩余50%胶体液量(新鲜冰冻血浆)在烧伤后16 h内输注;烧伤后第2个24 h的胶体液量使用新鲜冰冻血浆和人血白蛋白液,人血白蛋白液于烧伤36 h后输注;烧伤后第3、4个24 h根据血常规和生化检查补充人血白蛋白液。统计2组重症烧伤患者烧伤后第1、2、3、4个24 h输注的胶体液量、液体总入量、白蛋白补入量、每小时尿量;记录重症烧伤患者烧伤后第1、2、3、4个24 h血清白蛋白含量及烧伤48 h后红细胞比容、血红蛋白、血小板、C反应蛋白情况;计算2组烧伤48 h后休克指数。数据比较采用非配对样本t检验或非参数检验。结果烧伤后第1、2、3、4个24 h,试验组输入胶体液量分别为(0.37±0.15)、(0.23±0.10)、(0.07±0.01)、(0.02±0.01)mL·kg^(-1)·%TBSA^(-1),均少于对照组[(0.58±0.17)、(0.29±0.09)、(0.08±0.01)、(0.05±0.01)mL·kg^(-1)·%TBSA^(-1)],2组比较差异均有统计学意义(t=5.759、2.752、4.378、13.130,P<0.05);烧伤后第1、2、3、4个24 h,试验组液体总入量分别为(2.31±0.21)、(1.56±0.10)、(1.01±0.13)、(1.02±0.13)mL·kg^(-1)·%TBSA^(-1),均少于对照组[(2.55±0.22)、(1.62±0.14)、(1.13±0.25)、(1.09±0.25)mL·kg^(-1)·%TBSA^(-1)],差异均有统计学意义(t=4.894、2.183、2.689、1.568,P<0.05);试验组患者烧伤后第1、2个24 h的白蛋白补入量分别为(76.64±4.26)、(67.43±7.20)g,均高于对照组[(62.57±4.43)、(55.72±4.89)g],差异均有统计学意义(t=14.190、8.230,P<0.05);试验组伤后第3、4个24 h的白蛋白补入量分别为(44.07±4.46)、(24.49±5.25)g,均低于对照组[(46.68±6.06)、(38.65±7.01)g],差异均有统计学意义(t=2.169、10.110,P<0.05);试验组患者烧伤后第1、2、3个24 h的尿量均高于对照组,烧伤后第4个24 h的尿量低于对照组,差异均有统计学意义(t=2.363、2.194、3.591、11.170,P<0.05);烧伤后第1、2、3、4个24 h,试验组血清白蛋白含量均高于对照组,差异均有统计学意义(t=2.505、4.517、40.140、3.544,P<0.05)。烧伤48 h后,试验组红细胞比容、血红蛋白、C反应蛋白分别为(36.57±6.48)%、(121.16±13.16)g/L、(209.54±32.57)×10^(9)/L,与对照组[(39.83±7.47)%、(134.64±18.94)g/L、(116.72±39.84)×10^(9)/L]比较均降低,差异均有统计学意义(t=2.051、3.662、5.003,P<0.05);试验组血小板水平(30.67±9.27)mg/L,高于对照组[(40.52±7.69)mg/L],差异有统计学意义(t=11.240,P<0.05)。烧伤48 h后,试验组休克指数0.64±0.13,对照组休克指数0.76±0.12,试验组明显低于对照组,差异有统计学意义(t=4.189,P<0.05)。结论烧伤休克期早期使用人血白蛋白可以有效扩容,纠正低蛋白血症,减少液体复苏总入量,恢复脏器功能不全,为重症烧伤患者救治提供有利条件。
Objective To investigate the efficacy of early use of human serum albumin in severe burn patients with burn shock.Methods A total of 77 inpatients with severe burns admitted to the Department of Burns and Plastic Surgery,Shizuishan First People′s Hospital Affiliated to Ningxia Medical University from January 2019 to October 2021 were selected as the research objects,and the patients were randomly divided into the experimental group and the control group by random number table method,with 41 cases in the experimental group,36 cases in the control group.After admission,all patients received anti-infective treatment to protect the function of various organs,monitored various physiological indicators of patients,and bandaged the wound with silver ion dressing.In the experimental group,50%of the colloidal fluid in the 1st 24 hours after burn was infused with hydroxyethyl starch 130/0.4 sodium chloride solution and fresh frozen plasma within 8 hours of the burn,and the remaining 50%of the colloid was infused within 16 hours of the burn,the human albumin solution was infused 12 hours after the burn;the amount of colloid in the 2nd 24 hours was infused with fresh frozen plasma+human albumin solution;the 3rd and 4th 24 hours were supplemented with human albumin according to blood routine and biochemical tests.In the control group,50%of the colloid volume in the 1st 24 hours after burn was infused with 500 mL of hydroxyethyl starch 130/0.4 sodium chloride solution and fresh frozen plasma within 8 hours of burn,and the remaining 50%of the colloid volume(fresh frozen plasma)was infused within 16 hours of burn;the amount of colloid in the 2nd 24 hours was the fresh frozen plasma and human albumin solution,and human albumin was infused after 36 hours of burn;the 3rd and 4th 24 hours were based on blood routine and biochemical examinations supplement human serum albumin.The colloidal fluid volume,total fluid intake,albumin supplementation volume,and hourly urine volume in the 1st,2nd,3rd,and 4th 24 hours after burn in the two groups of severe burn patients were counted;serum albumin content in the 1st,2nd,3rd,and 4th 24 hours after burn,and hematocrit,hemoglobin,platelets,and C-reactive protein after 48 hours of burn were recorded;the shock index after 48 hours of burn in the two groups was calculated.Data were compared with unpaired samples t-test or nonparametric test.Results In the 1st,2nd,3rd,and 4th 24 hours after burn injury,the amount of colloidal fluid in the experimental group were(0.37±0.15),(0.23±0.10),(0.07±0.01),and(0.02±0.01)mL·kg^(-1)·%TBSA^(-1),respectively,all less than the control group[(0.58±0.17),(0.29±0.09),(0.08±0.01),(0.05±0.01)mL·kg^(-1)·%TBSA^(-1)],the differences between the two groups were statistically significant(t=5.759,2.752,4.378,13.130;P<0.05);at the 1st,2nd,3rd,and 4th 24 hours after burn,the total fluid intake in the experimental group were(2.31±0.21),(1.56±0.10),(1.01±0.13),(1.02±0.13)mL·kg^(-1)·%TBSA^(-1),which were all less than the control group[(2.55±0.22),(1.62±0.14),(1.13±0.25),(1.09±0.25)mL·kg^(-1)·%TBSA^(-1)],the differences were statistically significant(t=4.894,2.183,2.689,1.568;P<0.05).The amount of albumin supplemented in the 1st and 2nd 24 h after burn in the experimental group were(76.64±4.26),(67.43±7.20)g,which were higher than the control group[(62.57±4.43),(55.72±4.89)g],the differences were statistically significant(t=14.190,8.230;P<0.05).The amount of albumin supplementation in the experimental group in the 3rd and 4th 24 h after injury were(44.07±4.46)and(24.49±5.25)g,respectively,which were lower than those in the control group.group[(46.68±6.06),(38.65±7.01)g],the differences were statistically significant(t=2.169,10.110;P<0.05).The urine volume in the 1st,2nd,and 3rd 24 hours after burn in the experimental group were higher than that in the control group,and the urine volume in the 4th 24 hours after the burn was lower than that in the control group,and the differences were statistically significant(t=2.363,2.194,3.591,11.170;P<0.05).At the 1st,2nd,3rd,and 4th 24 hours after burn,the serum albumin content of the experimental group were higher than that of the control group,and the differences were statistically significant(t=2.505,4.517,40.140,3.544;P<0.05).After 48 hours of burn,the hematocrit,hemoglobin,and C-reactive protein in the experimental group were(36.57±6.48)%,(121.16±13.16)g/L,and(209.54±32.57)×10^(9)/L,respectively,compared with the control group[(39.83±7.47)%,(134.64±18.94)g/L,(116.72±39.84)×10^(9)/L],and the differences were statistically significant(t=2.051,3.662,5.003;P<0.05);the platelet level in the experimental group was(30.67±9.27)mg/L,which was higher than that in the control group[(40.52±7.69)mg/L],and the difference was statistically significant(t=11.240,P<0.05).After 48 hours of burns,the shock index of the experimental group was 0.64±0.13,and the shock index of the control group was 0.76±0.12,the experimental group was significantly lower than the control group,and the difference was statistically significant(t=4.189,P<0.05).Conclusion The use of human albumin in the early stage of burn shock can effectively expand the volume,correct hypoalbuminemia,reduce the total amount of fluid resuscitation,restore organ insufficiency,and provide favorable conditions for the treatment of severe burn patients.
作者
邓兴旺
齐旭辉
杨绍贤
张龙
金少华
杨涛
蒲文兰
李传吉
Deng Xingwang;Qi Xuhui;Yang Shaoxian;Zhang Long;Jin Shaohua;Yang Tao;Pu Wenlan;Li Chuanji(Department of Burns and Plastic Surgery, Shizuishan First People′s Hospital Affiliated to Ningxia Medical University, Shizuishan 753200, China)
出处
《中华损伤与修复杂志（电子版）》
CAS
2022年第1期47-53,共7页
Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)
基金
宁夏医科大学校级科研项目基金(XM-2019109)。
关键词
烧伤
休克
血清白蛋白
液体复苏
Burns
Shock
Serum albumin
Fluid resuscitation
作者简介
邓兴旺,硕士研究生,副主任医师。现任宁夏医学会烧伤外科学分会、整形外科学分会委员,宁夏中西医结合烧伤专业委员会副主任委员。2020年宁夏回族自治区“青年拔尖人才”,石嘴山市“351人才”。主持宁夏回族自治区卫生厅科研立项1项、宁夏医科大学校级2项,参与解放军总医院第四医学中心烧伤研究所首都医学发展科研基金子项目1项。累计发表核心专业学术论文15篇,以第一作者发表SCI论文3篇。擅长各种大面积烧伤的抢救治疗,手术、创伤后的瘢痕修复等;通信作者:李传吉,Email:xingwang306@163.com。
