The approach to fluid resuscitation in burn shock continues to be refined in step with improved knowledge of the complex fluid, electrolyte, and protein shifts that characterize this form of shock. Local burn tissue and generalized nonburn tissue edema occur initially after injury because of the release of histamine, which causes increased microvascular permeability. Subsequent edema formation in burned and nonburned tissue occurs according to distinctly different mechanisms. Burn tissue edema forms because of direct thermal injury to endothelial cells and increased burn tissue osmolarity. Nonburn tissue edema is attributed to severe hypoproteinemia caused by protein flux into burn-injured tissue. Interstitial protein depletion in nonburn tissue also increases the ease of water transport into the interstitial space. Cell damage occurs with ischemia caused by decreased perfusion. More cell damage can occur with reperfusion and the subsequent formation of oxygen radicals. Fluid therapy is designed to support the patient's cardiovascular system so as to restore and maintain tissue perfusion. General formulas serve as guidelines for the amount of fluid to infuse; however, fluid therapy should be tailored to the individual patient's needs based on factors such as extensiveness of burns, extremes of age, inhalation injury, pre-existing cardiopulmonary disease, and delayed fluid resuscitation. Ringer's lactate solution is the most common fluid used in the early postburn period. The addition of colloid to resuscitation efforts should begin as microvascular permeability is restored or immediately if the patient presents in frank shock. Continuous monitoring is necessary to judge the adequacy of fluid replacement.
随着对烧伤休克这种休克形式所特有的复杂液体、电解质和蛋白质转移的认识不断提高，烧伤休克的液体复苏方法也在不断完善。受伤后最初会出现局部烧伤组织和全身性非烧伤组织水肿，这是由于组胺释放导致微血管通透性增加所致。随后，烧伤组织和非烧伤组织中的水肿形成机制明显不同。烧伤组织水肿是由于内皮细胞受到直接热损伤以及烧伤组织渗透压升高所致。非烧伤组织水肿则归因于蛋白质流入烧伤损伤组织导致的严重低蛋白血症。非烧伤组织中的间质蛋白消耗也增加了水向间质间隙转运的容易程度。细胞损伤是由灌注减少导致的缺血引起的。再灌注以及随后氧自由基的形成会导致更多细胞损伤。液体疗法旨在支持患者的心血管系统，以恢复和维持组织灌注。通用公式可作为输液量的指导原则；然而，液体疗法应根据烧伤范围、年龄极端情况、吸入性损伤、既往心肺疾病以及延迟液体复苏等因素来满足个体患者的需求。乳酸林格氏液是烧伤后早期最常用的液体。如果患者出现明显休克，应在微血管通透性恢复时或立即开始在复苏过程中添加胶体。持续监测对于判断液体补充是否充足是必要的。
