Arlati S, Storti E, Pradella V, Bucci L, Vitolo A, Pulici M
Intensive Care Unit G. Bozza, Niguarda Cà-Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
Resuscitation. 2007 Mar;72(3):371-8. doi: 10.1016/j.resuscitation.2006.07.010. Epub 2006 Nov 29.
To evaluate the impact of decreased fluid resuscitation on multiple-organ dysfunction after severe burns. This approach was referred to as "permissive hypovolaemia".
Two cohorts of patients with burns>20% BSA without associated injuries and admitted to ICU within 6 h from the thermal injury were compared. Patients were matched for both age and burn severity. The multiple-organ dysfunction score (MODS) by Marshall was calculated for 10 days after ICU admission. Permissive hypovolaemia was administered by a haemodynamic-oriented approach throughout the first 24-h period. Haemodynamic variables, arterial blood lactates and net fluid balance were obtained throughout the first 48 h.
Twenty-four patients were enrolled: twelve of them received the Parkland Formula while twelve were resuscitated according to the permissive hypovolaemic approach. Permissive hypovolaemia allowed for less volume infusion (3.2+/-0.7 ml/kg/% burn versus 4.6+/-0.3 ml/kg/% burn; P<0.001), a reduced positive fluid balance (+7.5+/-5.4 l/day versus +12+/-4.7 l/day; P<0.05) and significantly lesser MODS Score values (P=0.003) than the Parkland Formula. Both haemodynamic variables and arterial blood lactate levels were comparable between the patient cohorts throughout the resuscitation period.
Permissive hypovolaemia seems safe and well tolerated by burn patients. Moreover, it seems effective in reducing multiple-organ dysfunction as induced by oedema fluid accumulation and inadequate O2 tissue utilization.
评估减少液体复苏对严重烧伤后多器官功能障碍的影响。这种方法被称为“允许性低血容量症”。
比较两组烧伤面积>20%体表面积且无合并伤、在热损伤后6小时内入住重症监护病房（ICU）的患者。患者在年龄和烧伤严重程度方面进行匹配。在入住ICU后的10天内计算Marshall多器官功能障碍评分（MODS）。在最初的24小时内采用以血流动力学为导向的方法实施允许性低血容量症。在最初的48小时内获取血流动力学变量、动脉血乳酸水平和液体净平衡。
共纳入24例患者：其中12例接受Parkland公式补液，12例根据允许性低血容量症方法进行复苏。允许性低血容量症组的输液量较少（3.2±0.7 ml/kg/%烧伤面积 vs 4.6±0.3 ml/kg/%烧伤面积；P<0.001），液体正平衡减少（+7.5±5.4升/天 vs +12±4.7升/天；P<0.05），且MODS评分值显著低于Parkland公式组（P=0.003）。在整个复苏期间，两组患者的血流动力学变量和动脉血乳酸水平相当。
允许性低血容量症对烧伤患者似乎是安全且耐受性良好的。此外，它似乎在减少因水肿液积聚和组织氧利用不足引起的多器官功能障碍方面有效。
