Wolfe R R
Circ Shock. 1981;8(1):105-15.
The acute response to burn injury is referred to as the ebb, or shock, phase. It is characterized as a hypodynamic state, with both cardiac output and metabolic rate being depressed. Hyperglycemia is evident, owing both to an increased rate of production of glucose and a peripheral "insulin resistance." Lactate production is markedly elevated, whereas the FFA response is variable. Clinically, the predominant concern is repletion of the plasma volume that was lost as a consequence of increased capillary permeability. If adequate fluid resuscitation is administered, recovery from burn shock can usually be accomplished. The chronic response to burn injury, or flow phase, may last for many weeks. It is a hyperdynamic state, with both cardiac output and metabolic rate being elevated. Without appropriate nutritional therapy, severe protein wasting can occur as a consequence of an accelerated rate of protein catabolism. The increase in protein catabolism is associated with an increase in the rate of glucose production. There appear to be changes in fat metabolism as well, but more quantitative studies are needed in this area. In general, improved emergency room treatment has greatly improved survival from burn shock, and the focus of much of the study of the response to burn injury has consequently shifted to the flow phase. In that regard, many important questions still remain unanswered. The most pressing problem to those interested in metabolism and nutrition is probably the identification of the signal for the metabolic response evident in the flow phase.
烧伤的急性反应被称为低潮期或休克期。其特征为低动力状态，心输出量和代谢率均降低。由于葡萄糖生成速率增加和外周“胰岛素抵抗”，高血糖很明显。乳酸生成显著升高，而游离脂肪酸反应则各不相同。临床上，主要关注点是补充因毛细血管通透性增加而丢失的血浆容量。如果给予足够的液体复苏，通常可以从烧伤休克中恢复。烧伤的慢性反应或血流期可能持续数周。这是一种高动力状态，心输出量和代谢率均升高。如果没有适当的营养治疗，由于蛋白质分解代谢加速，可能会发生严重的蛋白质消耗。蛋白质分解代谢的增加与葡萄糖生成速率的增加有关。脂肪代谢似乎也有变化，但该领域需要更多的定量研究。一般来说，急诊室治疗的改善大大提高了烧伤休克患者的存活率，因此对烧伤反应的许多研究重点已转向血流期。在这方面，许多重要问题仍然没有答案。对于关注代谢和营养的人来说，最紧迫的问题可能是确定血流期明显的代谢反应信号。
