Gong Chen, Zhang Fang, Li Lei, He Fang, Liu Gong-Cheng, Zhu Shi-Hui, Wang Guang-Yi, Xia Zhao-Fan
From the *Department of Burn Surgery, The Second Military Medical University affiliated Changhai Hospital, Shanghai, China; †Department of Plastic Surgery, The First People's Hospital of Zhengzhou, Zhengzhou, Henan, China; ‡No. 73901 Troop of PLA, Shanghai, China; and §No. 72510 Troop of PLA, Zhanjiang, China.
J Burn Care Res. 2017 Nov/Dec;38(6):e966-e972. doi: 10.1097/BCR.0000000000000533.
To investigate early hemodynamics of severely burned patients via PiCCO and to discuss clinical significance of hemodynamic monitoring for burn shock resuscitation, 55 extensive burn patients were enrolled in this retrospective study. The fluid resuscitation was guided according to Chinese General Formula and adjusted with urinary output of 0.5-1.0 ml/h/kg as a resuscitation goal. All patients were diagnosed within a relatively stable condition during burn shock stage, and they received PiCCO monitoring within 6 hours after burn. The preload parameter intrathoracic blood volume index was low at first, then returned to normal. The flow parameter cardiac index and myocardial contractility parameter dPmax were gradually changed from low level in the early stage to high level in the fluid reabsorption stage. The afterload parameter systemic vascular resistance index had completely opposite tendency. The lung-related parameters extravascular lung water index and pulmonary vascular permeability index were roughly in the normal range. The change of cardiac index had a linear regression relationship with dPmax and systemic vascular resistance index but had no significant relationship with intrathoracic blood volume index. Under effective fluid resuscitation, the early hemodynamics after burn is still in dynamically changing status, characterized as transition from low cardiac output (CO)-high vascular resistance in early shock stage to high CO-low vascular resistance in fluid reabsorption stage. CO mainly depends on the myocardial contractility and vascular resistance, but not on the blood volume. Excessive fluid resuscitation cannot get normal CO. The normal value of hemodynamics cannot be used as end point of burn shock resuscitation. Dynamic observation of hemodynamics is of great importance.
通过脉搏指示连续心输出量（PiCCO）技术研究重度烧伤患者的早期血流动力学，并探讨血流动力学监测在烧伤休克复苏中的临床意义，本回顾性研究纳入了55例大面积烧伤患者。液体复苏按照中国通用公式进行指导，并以尿量0.5 - 1.0 ml/h/kg作为复苏目标进行调整。所有患者均在烧伤休克期相对稳定的状态下被诊断，且在烧伤后6小时内接受了PiCCO监测。前负荷参数胸腔内血容量指数起初较低，随后恢复正常。血流参数心脏指数和心肌收缩力参数dPmax在早期从低水平逐渐变化至液体重吸收期的高水平。后负荷参数全身血管阻力指数则呈现完全相反的趋势。与肺相关的参数血管外肺水指数和肺血管通透性指数大致在正常范围内。心脏指数的变化与dPmax和全身血管阻力指数呈线性回归关系，但与胸腔内血容量指数无显著关系。在有效的液体复苏下，烧伤后的早期血流动力学仍处于动态变化状态，其特征为从早期休克阶段的心输出量（CO）低、血管阻力高转变为液体重吸收期的CO高、血管阻力低。CO主要取决于心肌收缩力和血管阻力，而非血容量。过度的液体复苏无法获得正常的CO。血流动力学的正常值不能作为烧伤休克复苏的终点。血流动力学的动态观察至关重要。
