Guo Z R, Sheng C Y, Diao L, Gao W Y, Yang H M, Lin H Y, Han J L
Trauma Center, 304th Hospital, Postgraduate Medical College of PLA, China.
Burns. 1995 Mar;21(2):139-42. doi: 10.1016/0305-4179(95)92140-8.
In order to reduce excessive plasma loss, to alleviate the effects of devitalized tissues on the body, and to shorten the time in hospital, we attempted to perform extensive escharectomy during the shock period in extensively burned patients. Group A consisted of 21 patients, aged 9-45 years, with a mean total burn area of 63.2 +/- 18.1 per cent TBSA, and full-thickness injury involving 35.9 +/- 19.6 per cent TBSA. The first escharectomy was performed at 24.1 +/- 13.9 h postburn. The excision area averaged 32.3 +/- 6.7 per cent TBSA (range 24-96 per cent). In 15 patients a Swan-Ganz catheter was introduced to monitor haemodynamic changes. It was found that RAP, PAP, PAWP, ABP, HR, CO and CI were all stable during and after the operation. Group B consisted of 29 patients, and escharectomy was begun 4-5 days postburn. The mean healing time of the patients in group A was 33.1 days, which was shorter than that in group B (40.1 days). The period of haemoconcentration was shorter in group A and the amount of blood required during the first 2 weeks was almost 700 ml less in group A. There were fewer visceral complications in group A and smaller amounts of antibiotics were required in this group. The authors believe that escharectomy during the shock stage is feasible.
为减少过多的血浆丢失，减轻失活组织对机体的影响，并缩短住院时间，我们尝试对大面积烧伤患者在休克期进行广泛的焦痂切除。A组由21例患者组成，年龄9 - 45岁，平均烧伤总面积为63.2±18.1%TBSA，Ⅲ度烧伤面积为35.9±19.6%TBSA。首次焦痂切除在伤后24.1±13.9小时进行。切除面积平均为32.3±6.7%TBSA（范围24 - 96%）。15例患者置入Swan - Ganz导管监测血流动力学变化。发现术中及术后RAP、PAP、PAWP、ABP、HR、CO和CI均稳定。B组由29例患者组成，焦痂切除在伤后4 - 5天开始。A组患者平均愈合时间为33.1天，短于B组（40.1天）。A组血液浓缩期较短，且前2周所需输血量比B组少近700ml。A组内脏并发症较少，且该组所需抗生素量也较少。作者认为休克期进行焦痂切除是可行的。
