严重烧伤创伤后的肾功能——减少复苏液量及改变液体张力的影响
Renal function after severe burn trauma - effects of reducing resuscitation fluid volume and changing fluid tonicity.
作者信息
Gigengack Rolf K, Dijkstra Annemieke, Cleffken Berry I, Loer Stephan A, Koopman J Seppe H A, Van der Vlies Cornelis H
机构信息
Departments of Trauma and Burn Surgery, Maasstad Hospital, Maasstadweg 21, Rotterdam 3079 DZ, the Netherlands; Amsterdam UMC, Amsterdam, Department of Intensive Care, De Boelelaan 1117, Amsterdam 1081HV, the Netherlands; Amsterdam UMC, Amsterdam, Department of Anesthesiology, De Boelelaan 1117, Amsterdam 1081HV, the Netherlands.
Department of Intensive care, Van Weel Bethesda, Stationsweg 22, Dirksland 3247 BW, the Netherlands; Department of Intensive care, Maasstad Hospital, Maasstadweg 21, Rotterdam 3079 DZ, the Netherlands; Department of Intensive Care Adults, Erasmus MC, University Medical Center Rotterdam, Erasmus University, Dr. Molewaterplein 40, Rotterdam 3015 GD, the Netherlands.
出版信息
Burns. 2025 Aug 7;51(8):107655. doi: 10.1016/j.burns.2025.107655.
BACKGROUND
Severe burn trauma can significantly impair renal function with increased morbidity and mortality. To preserve renal function after burn trauma, fluid resuscitation should be adequate avoiding hypo- as well as hypervolemia. In 2018, the Dutch Burn Society revised its resuscitation guideline from 4 mL/kg/TBSA hypertonic solution to 3 mL/kg/TBSA isotonic solution. This study analyzes the effects of these changes in the fluid resuscitation protocol on renal function.
METHODS
In this retrospective, single-center, cohort study, we included adult patients with a burn injury of at least 15 % of their total body surface area (≥ 15 % TBSA). The inclusion period lasted from 2.5 years before until 2.5 years after the modification of the fluid resuscitation protocol. We compared the effects of both protocols (4 mL/kg/TBSA hypertonic solution versus 3 mL/kg/TBSA isotonic solution) on renal function, as assessed by glomerular filtration rate, plasma creatinine concentration and urinary output, the incidence of AKI, and the need for renal replacement therapy.
RESULTS
We included 108 patients with a median burned TBSA of 22 %, 52 patients receiving 4 mL/kg/TBSA hypertonic solution, and 56 patients receiving 3 mL/kg/TBSA isotonic solution. Baseline characteristics were similar between both groups (mean age 44 years). No significant differences were observed in renal function, need for renal replacement therapy, urinary output, incidence of acute kidney injury, or mortality.
DISCUSSION
Determining the optimal fluid volume and composition for resuscitation of patients with severe burn trauma remains challenging. In our study, reducing the initial resuscitation volume from 4 to 3 mL/kg/TBSA and switching from a hypertonic to an isotonic solution showed no adverse effects on renal function after severe burn trauma. Future studies should investigate whether individualized strategies can help to reach the sweet spot of fluid resuscitation.
背景
严重烧伤创伤可显著损害肾功能，增加发病率和死亡率。为了在烧伤创伤后保护肾功能，液体复苏应充分，避免低血容量和高血容量。2018年，荷兰烧伤协会将其复苏指南从4毫升/千克/总体表面积的高渗溶液改为3毫升/千克/总体表面积的等渗溶液。本研究分析了液体复苏方案的这些变化对肾功能的影响。
方法
在这项回顾性、单中心队列研究中，我们纳入了烧伤面积至少占其体表面积15%（≥15% TBSA）的成年患者。纳入期从液体复苏方案修改前2.5年持续到修改后2.5年。我们比较了两种方案（4毫升/千克/总体表面积的高渗溶液与3毫升/千克/总体表面积的等渗溶液）对肾功能的影响，肾功能通过肾小球滤过率、血浆肌酐浓度和尿量来评估，急性肾损伤的发生率以及肾脏替代治疗的需求。
结果
我们纳入了108例患者，中位烧伤TBSA为22%，52例患者接受4毫升/千克/总体表面积的高渗溶液，56例患者接受3毫升/千克/总体表面积的等渗溶液。两组的基线特征相似（平均年龄44岁）。在肾功能、肾脏替代治疗需求、尿量、急性肾损伤发生率或死亡率方面未观察到显著差异。
讨论
确定严重烧伤创伤患者复苏的最佳液体量和成分仍然具有挑战性。在我们的研究中，将初始复苏量从4毫升/千克/总体表面积减少到3毫升/千克/总体表面积，并从高渗溶液改为等渗溶液，对严重烧伤创伤后的肾功能没有不良影响。未来的研究应调查个体化策略是否有助于达到液体复苏的最佳平衡点。
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