Küntscher Markus V, Germann Günter, Hartmann Bernd
Department for Hand, Plastic and Reconstructive Surgery, Burn Center, BG, Trauma Center Ludwigshafen, Plastic & Hand Surgery, The University of Heidelberg, Berlin, Germany.
Resuscitation. 2006 Jul;70(1):37-43. doi: 10.1016/j.resuscitation.2005.12.001. Epub 2006 Jun 8.
The purpose of this study was to observe the interactions between cardiac index (CI), stroke volume index (SVI), central venous pressure (CVP), intra-abdominal pressure (IAP) and total circulating blood volume index (TBVI) during resuscitation of major burns. Sixteen patients with an average TBSA of 46% (26-67%) and an average abbreviated burn severity index of 8.9 (7-11) were included into an intra-individual comparative prospective study over an 18-month period. The COLD Z-021 system (Pulsion Medical Systems, Munich, Germany) was used to obtain CI, SVI and TBVI. Two hundred and thirty-four to 278 intra-individually comparative measurements were performed for the analyses during the first 4 days after the burn injury. Correlations were shown for the interactions between CI and TBVI (r = 0.550; rs = 0.518), SVI and TBVI (r = 0.606; rs = 0.626) and for CVP versus IAP (r = 0.487; rs = 0.474). Poor or no correlations were demonstrated for the comparisons CI versus CVP (r = 0.401; rs = 0.352), CVP-PEEP versus IAP (r = 0.255; rs = 0.272). TBVI versus IAP (r = -0.120; rs = -0.169), TBVI versus CVP (r = 0.025; rs = -0.036), TBVI versus CVP-PEEP (r = -0.046; rs = -0.101), CI versus CVP-PEEP (r = 0.088; rs = 0.092) as well as for IAP versus CI (r = 0.050; rs = 0.034). An additional analysis demonstrated no correlation between TBVI and MAP (r = -0.095; rs = -0.136). Our data provide evidence that the CVP is influenced more by external pressures (IAP) than by the actual intravascular volume status of the patient. Thus, the CVP is not a suitable tool to guide fluid resuscitation during burns with shock. The TBVI may be an ideal value to guide resuscitation because the augmentation of TBVI during fluid resuscitation correlated well with improved cardiac output and stroke volume. Future randomised studies are required to demonstrate whether TBVI guided resuscitation of burns has an impact on outcome.
本研究的目的是观察大面积烧伤复苏过程中心脏指数（CI）、每搏量指数（SVI）、中心静脉压（CVP）、腹腔内压（IAP）和总循环血容量指数（TBVI）之间的相互作用。16例患者纳入一项为期18个月的个体内比较前瞻性研究，平均烧伤总面积为46%（26%-67%），平均简化烧伤严重程度指数为8.9（7-11）。使用COLD Z-021系统（德国慕尼黑普ulsion医疗系统公司）获取CI、SVI和TBVI。在烧伤后第1天至第4天进行了234至278次个体内比较测量用于分析。结果显示CI与TBVI（r = 0.550；rs = 0.518）、SVI与TBVI（r = 0.606；rs = 0.626）以及CVP与IAP之间存在相关性（r = 0.487；rs = 0.474）。而CI与CVP（r = 0.401；rs = 0.352）、CVP-PEEP与IAP（r = 0.255；rs = 0.272）、TBVI与IAP（r = -0.120；rs = -0.169）、TBVI与CVP（r = 0.025；rs = -0.036）、TBVI与CVP-PEEP（r = -0.046；rs = -0.101）、CI与CVP-PEEP（r = 0.088；rs = 0.092）以及IAP与CI（r = 0.050；rs = 0.034）之间的相关性较差或无相关性。另一项分析表明TBVI与平均动脉压之间无相关性（r = -0.095；rs = -0.136）。我们的数据表明，CVP受外部压力（IAP）的影响大于患者实际血管内容量状态的影响。因此，CVP不是指导烧伤休克期液体复苏的合适指标。TBVI可能是指导复苏的理想指标，因为液体复苏期间TBVI的增加与心输出量和每搏量的改善密切相关。未来需要进行随机研究以证明TBVI指导的烧伤复苏是否对预后有影响。
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