[烧伤早期不同液体复苏方案对血浆钠水平和血液红细胞变化的临床研究]

[Clinical study on the changes in plasma sodium level and blood erythrocyte after resuscitation with different fluid regimes at early postburn stage].

作者信息

Chen Xin-long, Xia Zhao-fan

机构信息

Department of Burns, Changhai Hospital, The Second Military Medical University, Shanghai 200433, P.R. China.

出版信息

Zhonghua Shao Shang Za Zhi. 2004 Oct;20(5):284-6.

PMID:15730653

Abstract

OBJECTIVE

To study the changes in plasma sodium level and blood erythrocyte after resuscitation with different fluid regimes at early postburn stage.

METHODS

One hundred and fifty burn patients admitted to our burn ward were randomly divided into three groups based on the different regimes of fluid resuscitation, i.e. A (n = 50, resuscitation with balanced salt solution for to the patients with middle and small burn area, Na(+) = 130 mmol/L); B (n = 50, with the same regime as in group A for those with large burn area), and C (n = 50, with hypertonic saline resuscitation for those with large burn area, Na(+) = 174 mmol/L) groups. The fluid supplementation, and changes in plasma sodium level and blood erythrocyte count, and the mean corpuscular volume (MCV) were observed during 1st to 3rd post burn day (PBD).

RESULTS

The average volume of fluid supplementation in C group was lower than that in A and B groups (P < 0.01), though the average sodium supplementation in C group was higher than that in B group within 3 PBDs (P < 0.01). The average plasma level of sodium in B group was obviously lower than that in C group within 3 PBDs (P < 0.05). Negative correlation between the plasma sodium level and burn index (BI) was observed in A and B group on 1 PBD (r = -0.84, P < 0.01). The plasma sodium level was in the lower margin of normal range (137.4 +/- 3.9) mmol/L in B group, while that in C group was in the higher margin of normal range with obvious difference compared with B and C groups (P < 0.05 or 0.01). The MCV in group was lower than that in B group on the 1st and 2nd PBD, i.e. (92.1 +/- 4.5) fl vs (95.5 +/- 5.5) fl on the 1st PBD, and (90.9 +/- 5.4) fl vs (93.2 +/- 6.4) fl on the 2nd PBD, P > 0.05).

CONCLUSION

The plasma sodium level was stable with milder degree of swelling of the erythrocytes when hypertonic saline resuscitation was given to patients with large burn area during early postburn stage.

摘要

目的

研究烧伤后早期不同液体复苏方案对血浆钠水平和血液红细胞的影响。

方法

将我院烧伤病房收治的150例烧伤患者根据液体复苏方案不同随机分为三组，即A组（n = 50，中小面积烧伤患者用平衡盐溶液复苏，Na(+) = 130 mmol/L）；B组（n = 50，大面积烧伤患者采用与A组相同的方案）；C组（n = 50，大面积烧伤患者用高渗盐水复苏，Na(+) = 174 mmol/L）。观察伤后第1至3天的补液量、血浆钠水平、红细胞计数及平均红细胞体积（MCV）的变化。

结果

C组补液总量低于A、B组（P < 0.01），伤后3天内C组钠补充总量高于B组（P < 0.01）。伤后3天内B组血浆钠平均水平明显低于C组（P < 0.05）。伤后第1天A、B组血浆钠水平与烧伤指数（BI）呈负相关（r = -0.84，P < 0.01）。B组血浆钠水平处于正常范围下限（137.4 ± 3.9）mmol/L，C组处于正常范围上限，与B组比较差异明显（P < 0.05或0.01）。伤后第1天和第2天C组MCV低于B组，即第1天（92.1 ± 4.5）fl对（95.5 ± 5.5）fl，第2天（90.9 ± 5.4）fl对（93.2 ± 6.4）fl，P > 0.05）。