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首页> 外文期刊>Resuscitation. >Decreased fluid volume to reduce organ damage: a new approach to burn shock resuscitation? A preliminary study.
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Decreased fluid volume to reduce organ damage: a new approach to burn shock resuscitation? A preliminary study.

机译：减少液体量以减少器官损伤：烧伤休克复苏的新方法？初步研究。

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OBJECTIVE: To evaluate the impact of decreased fluid resuscitation on multiple-organ dysfunction after severe burns. This approach was referred to as "permissive hypovolaemia". METHODS: Two cohorts of patients with burns>20% BSA without associated injuries and admitted to ICU within 6 h from the thermal injury were compared. Patients were matched for both age and burn severity. The multiple-organ dysfunction score (MODS) by Marshall was calculated for 10 days after ICU admission. Permissive hypovolaemia was administered by a haemodynamic-oriented approach throughout the first 24-h period. Haemodynamic variables, arterial blood lactates and net fluid balance were obtained throughout the first 48 h. RESULTS: Twenty-four patients were enrolled: twelve of them received the Parkland Formula while twelve were resuscitated according to the permissive hypovolaemic approach. Permissive hypovolaemia allowed for less volume infusion (3.2+/-0.7 ml/kg/% burn versus 4.6+/-0.3 ml/kg/% burn; P<0.001), a reduced positive fluid balance (+7.5+/-5.4 l/day versus +12+/-4.7 l/day; P<0.05) and significantly lesser MODS Score values (P=0.003) than the Parkland Formula. Both haemodynamic variables and arterial blood lactate levels were comparable between the patient cohorts throughout the resuscitation period. CONCLUSIONS: Permissive hypovolaemia seems safe and well tolerated by burn patients. Moreover, it seems effective in reducing multiple-organ dysfunction as induced by oedema fluid accumulation and inadequate O2 tissue utilization.
机译：目的：评估减少液体复苏对严重烧伤后多器官功能障碍的影响。这种方法被称为“允许性低血容量”。方法：比较两组烧伤> 20％BSA且无相关损伤并在热损伤后6 h内入住ICU的患者。根据年龄和烧伤严重程度对患者进行匹配。在ICU入院10天后，计算了Marshall的多器官功能障碍评分（MODS）。在整个最初的24小时内，均以血流动力学为导向进行允许的低血容量。在整个前48小时内获得血流动力学变量，动脉血乳酸和净液平衡。结果：招募了24位患者：其中12位接受了帕克兰配方，而12位根据允许的降血容量方法进行了复苏。允许的低血容量可以减少输液量（3.2 +/- 0.7 ml / kg /％灼伤与4.6 +/- 0.3 ml / kg /％灼伤; P <0.001），减少的正液平衡（+7.5 +/- 5.4 l /天与+12 +/- 4.7升/天; P <0.05），并且MODS得分值（P = 0.003）明显低于Parkland公式。在整个复苏期间，患者队列之间的血流动力学变量和动脉血乳酸水平相当。结论：烧伤患者允许低血容量，安全且耐受性良好。而且，它似乎可以有效地减轻由于水肿积聚和O2组织利用率不足引起的多器官功能障碍。

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