Guo Z, Sheng Z, Diao L, Gao W, Yang H, Lin H, Han J
Trauma Center, 304th Hospital, Postgraduate Medical College of PLA, Beijing.
Chin Med J (Engl). 1995 Apr;108(4):273-7.
To stop excessive plasma loss, alleviate noxious effects of devitalized tissues on the body and shorten the hospitalization time, we performed extensive escharectomy during the shock period in extensively burned patients. Group A consisted of 21 patients aged 9-45 years (26.1 +/- 7.9 years), with a mean total burn area of 63.2% +/- 18.1% TBSA, and full-thickness injury involving 35.9% +/- 19.6% TBSA. The first escharectomy was done at 24.1 +/- 13.9 hours postburn, and excision area averaged 32.3% +/- 6.7% TBSA (24%-46%). In 15 of them, Swan-Ganz catheter was introduced to monitor the hemodynamic 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 aged 11-50 years (30.4 +/- 11.7 years), in whom escharectomy was begun 4-5 days postburn. The mean healing time of the patients in group A was 33.1 days, shorter than that of group B patients (40.1 days). The duration of hemoconcentration was shorter in group A. The amount of blood transfusion was almost 700 ml less in group A during the first two weeks. Less antibiotics were used with fewer visceral complications in group A. We believe that escharectomy during the burn shock stage is feasible.
为了阻止血浆过度丢失，减轻失活组织对机体的有害影响并缩短住院时间，我们对大面积烧伤患者在休克期进行了广泛的焦痂切除手术。A组由21例年龄在9至45岁（平均26.1±7.9岁）的患者组成，平均烧伤总面积为63.2%±18.1%TBSA，全层烧伤面积占35.9%±19.6%TBSA。首次焦痂切除在烧伤后24.1±13.9小时进行，切除面积平均为32.3%±6.7%TBSA（24%-46%）。其中15例患者置入Swan-Ganz导管以监测血流动力学变化。结果发现，术中及术后RAP、PAP、PAWP、ABP、HR、CO和CI均保持稳定。B组由29例年龄在11至50岁（平均30.4±11.7岁）的患者组成，他们在烧伤后4至5天开始进行焦痂切除。A组患者的平均愈合时间为33.1天，短于B组患者（40.1天）。A组血液浓缩持续时间较短。A组在前两周的输血量比B组少近700毫升。A组使用的抗生素较少，内脏并发症也较少。我们认为在烧伤休克期进行焦痂切除是可行的。
