Jones Ian F, Nakarmi Kiran, Wild Hannah B, Nsaful Kwesi, Mehta Kajal, Shrestha Raslina, Roubik Daniel, Stewart Barclay T
Madigan Army Medical Center, Tacoma, WA 98431, USA.
Nepal Cleft and Burn Center, Kirtipur 44600, Nepal.
Eur Burn J. 2024 Jan 18;5(1):23-37. doi: 10.3390/ebj5010003.
Burn injuries are a constant threat in war. Aspects of the modern battlefield increase the risk of burn injuries and pose challenges for early treatment. The initial resuscitation of a severely burn-injured patient often exceeds the resources available in front-line medical facilities. This stems mostly from the weight and volume of the intravenous fluids required. One promising solution to this problem is enteral resuscitation with an oral rehydration solution. In addition to being logistically easier to manage, enteral resuscitation may be able to mitigate secondary injuries to the gut related to burn shock and systemic immunoinflammatory activation. This has been previously studied in burn patients, primarily using electrolyte solutions, with promising results. Modern ORS containing sodium, potassium, and glucose in ratios that maximize gut absorption may provide additional benefits as a resuscitation strategy, both in terms of plasma volume expansion and protection of the barrier and immune functions of the gut mucosa. While enteral resuscitation is promising and should be used when other options are not available, further research is needed to refine an optimal implementation strategy.
烧伤在战争中始终是一种威胁。现代战场的诸多因素增加了烧伤风险，并给早期治疗带来挑战。严重烧伤患者的初始复苏往往超出一线医疗设施的可用资源。这主要源于所需静脉输液的重量和体积。解决这一问题的一个有前景的办法是使用口服补液溶液进行肠内复苏。除了在后勤管理上更简便之外，肠内复苏或许能够减轻与烧伤休克和全身免疫炎症激活相关的肠道继发性损伤。此前已在烧伤患者中对此进行研究，主要使用电解质溶液，结果很有前景。含有钠、钾和葡萄糖且比例能使肠道吸收最大化的现代口服补液盐作为一种复苏策略，在扩充血浆容量以及保护肠道黏膜屏障和免疫功能方面可能会带来更多益处。虽然肠内复苏很有前景，且在没有其他选择时应予以采用，但仍需要进一步研究以完善最佳实施策略。
