Wassermann D
Service des brûlés, hôpital Cochin, 27, rue du faubourg Saint-Jacques, 75014 Paris, France.
Ann Chir Plast Esthet. 2001 Jun;46(3):196-209. doi: 10.1016/s0294-1260(01)00017-6.
Burns covering more than 10% of the total body surface area (TBSA) are responsible for systemic perturbations which, in very severe cases, can represent a vital risk and, in all cases, affect the wound evolution. Among these general perturbations, fluid volume and electrolyte changes, leading eventually to burn shock, have the most dramatic consequences. Burn shock is, still to day, a vital risk and can also, in case of inadequate early fluid resuscitation, results in secondary morbidity and mortality. Fluid replacement during the very first hours after injury represents certainly a key point of the management of severe burn cases. Estimation of resuscitation fluid needs during this period is frequently underestimated. For adult, we recommend, during the first hour, a minimum of one liter for all severe injuries and two liters if the injury exceeds 50% of TBSA. Pulmonary injuries due to smoke inhalation are frequent, about 25% of patients hospitalized in burn units, and responsible for numerous death at site of house fires. In burn units, about 25% of hospitalized patients have pulmonary injuries in relation with smoke inhalation. This population has a high mortality rate increasing with the area of the skin injury and with age. Patients with inhalation injury need more resuscitation fluids, are subject to pneumonia and necessitate frequently mechanical ventilation. Parameters of the mechanical ventilation have to be choice to avoid barotrauma. Severe burn patients are submitted to a very high metabolic level. This can leads to a deep nutritional deficit responsible for an immunological suppression. It is then of major importance to provide an adequate nutritional support. It is also necessary to fight against the stress and to put the patient in a warm environment. Finally, infection is the most frequent and the most severe complication of burn injuries. Everything have to be done to avoid bacteriological contamination including architecture, equipment's, care procedure, nutritional support, types of wound dressing and most importantly surgery. Surgical procedures have to be done as earliest as possible to excise necrosis and cover the wound.
烧伤面积超过全身表面积（TBSA）10%会引发全身紊乱，在极其严重的情况下，这可能构成生命危险，并且在所有情况下都会影响伤口愈合。在这些全身性紊乱中，液体量和电解质变化最终会导致烧伤休克，其后果最为严重。时至今日，烧伤休克仍然是一种危及生命的情况，而且如果早期液体复苏不充分，还可能导致继发性发病和死亡。受伤后的最初几个小时内进行液体补充无疑是严重烧伤病例治疗的关键环节。在此期间，复苏液体需求量常常被低估。对于成年人，我们建议在伤后的第一个小时内，所有严重烧伤至少补充1升液体，如果烧伤面积超过TBSA的50%，则补充2升液体。吸入烟雾导致的肺部损伤很常见，约占烧伤科住院患者的25%，并且是家庭火灾现场众多死亡的原因。在烧伤科，约25%的住院患者存在与吸入烟雾相关的肺部损伤。这部分人群死亡率很高，且随着皮肤损伤面积的增大和年龄的增长而升高。吸入性损伤的患者需要更多的复苏液体，易患肺炎，且常常需要机械通气。必须选择合适的机械通气参数以避免气压伤。严重烧伤患者处于非常高的代谢水平。这可能导致严重的营养缺乏，进而引起免疫抑制。因此，提供充足的营养支持至关重要。同时，还必须应对应激反应，并为患者营造温暖的环境。最后，感染是烧伤最常见、最严重的并发症。必须采取一切措施避免细菌污染，包括建筑设计、设备、护理程序、营养支持、伤口敷料类型，最重要的是手术。手术必须尽早进行，以切除坏死组织并覆盖伤口。
