Department of Burn and Plastic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China.
Ann Palliat Med. 2021 Oct;10(10):10904-10912. doi: 10.21037/apm-21-2587.
A monitoring method is needed to further guide fluid resuscitation in severe burn injury. This study was performed to investigate the effects of pulse contour cardiac output (PCCO) monitoring on the prognosis of adult severe burns patients.
We conducted a retrospective study enrolling patients from January 2015 to December 2020, who were divided into a control group receiving conventional monitoring and a study group receiving PCCO monitoring. The primary outcomes were 28-day mortality and total mortality, and the secondary outcomes included burn-related complications and the length of hospital stay and ICU stay. Multivariable logistic regression analysis and linear regression analysis were performed to determine the risk factors of burns-related complications and length of hospital stay in enrolled patients.
A total of 109 patients in the control group and 82 patients in the study group were enrolled. While the area of full thickness burn was much higher in the control group than in the study group (P=0.021), no significant difference was found in other characteristics between the two groups. During fluid resuscitation, the fluid volume ratio of the study group was significantly different from that of the control group, and both in the first 24 hours and the second 24 hours, the resuscitation fluid volume ratio and colloid volume ratio was significantly higher in the control group than in the study group (all P<0.001). Eight patients died during treatment, and there were more patients experiencing AKI and ARDS in the control group than in the study group (P=0.029 and 0.016). The lengths of hospital stay and ICU stay in the study group was much shorter than in the control group (P<0.001 and 0.005). In addition, TBSA was an important risk factor for both AKI and ARDS, and the existence of inhalation injury and older age increased the incidence of ARDS. Higher TBSA, inhalation injury, and burn-related complications were related to longer hospital stay in enrolled patients.
Fluid resuscitation according to PCCO monitoring can effectively reduce the volume of colloid and overall fluid volume and reduce the incidence of burns-related complications and shorten the length of hospital stay.
需要一种监测方法来进一步指导严重烧伤患者的液体复苏。本研究旨在探讨脉搏轮廓心输出量（PCCO）监测对成人严重烧伤患者预后的影响。
我们进行了一项回顾性研究，纳入了 2015 年 1 月至 2020 年 12 月期间的患者，分为接受常规监测的对照组和接受 PCCO 监测的研究组。主要结局为 28 天死亡率和总死亡率，次要结局包括烧伤相关并发症以及住院和 ICU 住院时间。采用多变量逻辑回归分析和线性回归分析确定纳入患者烧伤相关并发症和住院时间的危险因素。
对照组共纳入 109 例患者，研究组共纳入 82 例患者。虽然对照组的全层烧伤面积明显高于研究组（P=0.021），但两组的其他特征无显著差异。在液体复苏过程中，研究组的液体量比与对照组明显不同，且在 24 小时内和第 2 个 24 小时内，对照组的复苏液体量比和胶体量比均明显高于研究组（均 P<0.001）。8 例患者在治疗过程中死亡，对照组中 AKI 和 ARDS 的患者多于研究组（P=0.029 和 0.016）。研究组的住院和 ICU 住院时间明显短于对照组（P<0.001 和 0.005）。此外，TBSA 是 AKI 和 ARDS 的重要危险因素，吸入性损伤和年龄较大增加了 ARDS 的发生率。较高的 TBSA、吸入性损伤和烧伤相关并发症与纳入患者的住院时间延长有关。
根据 PCCO 监测进行液体复苏可有效减少胶体和总液体量，降低烧伤相关并发症的发生率，并缩短住院时间。
