【摘要】 目的对比分析导向性限制性液体管理策略（restrictive fluid management strategy,RFMS）对重度烧伤合并吸入性损伤患者的影响。方法回顾性分析2016年5月至2019年5月郑州大学第一附属医院收治的48例重度烧伤合并吸入性损伤患者的病历资料,并将采用RFMS治疗的20例患者设为导向治疗组,采用常规液体管理治疗的28例患者设为常规治疗组,对比两组患者伤后3～7 d的24 h总入量、24 h总出量、血乳酸值、氧合指数以及伤后28 d内的机械通气时间与急性呼吸窘迫综合征（ARDS）发生情况。结果 （1）伤后3～7 d,两组患者24 h总入量无明显差异（t=1.977、1.975、1.956、1.670、1.987,P=0.054、0.054、0.057、0.102、0.053）;除伤后3d两组患者24 h总出量无明显差异（t=1.847,P=0.071）外,伤后4～7 d,导向治疗组患者24 h总出量均明显高于常规治疗组（t=4.053、2.939、3.068、2.470,P=0.000、0.005、0.004、0.017）。（2）伤后3～4 d,两组患者血乳酸值与氧合指数无明显差异（血乳酸值:t=0.273、0.244,P=0.786、0.809;氧合指数:t=0.711、1.111,P=0.481、0.272）;伤后5～7 d,导向治疗组患者血乳酸值明显低于常规治疗组（t=2.086、4.247、10.216,P=0.043、0.000、0.000）,氧合指数明显高于常规治疗组（t=2.778、2.092、2.811,P=0.008、0.042、0.007）。（3）伤后28 d内,导向治疗组患者机械通气时间明显短于常规治疗组（t=2.717,P=0.009）,ARDS发生率明显低于常规治疗组（χ2=3.918,P=0.048）。结论在满足液体复苏基本目标的前提下,伤后3～7 d以血管外肺水指数（extravascular lung water index,EVLWI）≤7 mL·kg^-1·m^-2为液体治疗导向指标,对患者实施RFMS既能维持血流动力学稳定,保证组织灌注充足,又能促进液体负平衡,改善氧合状态及肺功能,减少ARDS的发生。更多还原

【Abstract】 Objective To explore the influence of directed restrictive fluid management strategy（RFMS） on patients with severe burns complicated by inhalation injury.Methods Retrospective analysis was performed on the 48 patients with severe burns complicated by inhalation injuries,admitted to The First Affiliated Hospital of Zhengzhou University from May 2016 to May 2019.Twenty patients treated with RFMS were enrolled in directed treatment group and twenty-eight patients treated with routine liquid management were enrolled in routine treatment group.The total fluid intake and total fluid output within 24 h,value of blood lactic acid and oxygenation index on day 3-7 post injury,and mechanical ventilation time and incidence of acute respiratory distress syndrome（ARDS） within 28 days after the injury were compared between the two groups.Results（1） On day 3-7 post injury,no significant difference was observed in the total fluid intake within 24 h between the two groups（t= 1.977,1.975,1.956,1.670,1.987,P=0.054,0.054,0.057,0.102,0.053）;on day 3 post injury,no significant difference was seen in the total fluid output within 24 h between the two groups（t= 1.847,P=0.071）,but on day 4-7 post injury,the total fluid outputs in the directed treatment group were significantly higher than that in the routine treatment group（t=4.053,2.939,3.068,2.470,P=0.000,0.005,0.004,0.017）.（2） On day 3-4 post injury,no significant difference was observed in the values of blood lactic acid and oxygenation index between the two groups（values of blood lactic acid:t=0.273,0.244,P=0.786,0.809;oxygenation index:t=0.711,1.111,P= 0.481,0.272）;on day 5-7 post injury,the values of blood lactic acid of patients in the directed treatment group were significantly lower than that in the routine treatment group（t= 2.086,4.247,10.216,P=0.043,0.000,0.000）,and the oxygenation indexes were significantly higher（t=2.778,2.092,2.811,P=0.008,0.042,0.007）.（3） Within 28 days after the injury,the mechanical ventilation time of patients in the directed treatment group was significantly shorter than that in the routine treatment group（t= 2.717,P=0.009）,and the incidence of ARDS was significantly lower,too（χ²= 3.918,P=0.048）.Conclusion On the premise that basic objectives of fluid resuscitation are met,with the aim of maintaining extravascular lung water index（EVLWI） ≤7 mL·kg^-1·m^-2 on day 3-7 post injury,applying RFMS can not only maintain hemodynamic stability and ensure adequate tissue perfusion,but also promote negative fluid balance,improve oxygenation state and lung function,hence reducing the incidence of ARDS.更多还原