【作者】 胡祖良； 王新刚； 张元海； 叶春江； 张建芬； 蒋瑞明； 倪良方； 韩春茂；

【Author】 ZHANG Yuan-hai;WANG Xin-gang;YE Chun-jiang;ZHANG Jian-fen;LIU Liping;JIANG Rui-ming;NI Liang-fang;HAN Chun-mao;Department of Burn and Plastic Surgery,Quhua Hospital of Zhejiang Province;

【机构】 浙江省衢化医院烧伤整形科； 浙江大学医学院附属第二医院烧伤科；

【摘要】 目的:探讨静脉结合皮下注射葡萄糖酸钙治疗氢氟酸烧伤的疗效及安全性。方法:2006年1月至2013年8月收治的81例HF烧伤患者,烧伤面积(包括Ⅰ度):≤1%TBSA15例,1~5%TBSA52例,6~10%TBSA8例,1 1~30%TBSA5例,31~50%TBSA1例;合并吸入性损伤5例,其中轻度3例,中重度各1例;10例伴有眼烧伤。入院后立即建立静脉通道,静脉内注射葡萄糖酸钙2.0克,对烧伤面积≥5%TBSA或伴有吸入性损伤的患者,继续以0.5g/h速度静脉内微量泵注入,动态监测血电解质,如血钙高于2.5mmol/L暂停静脉注射。皮下注射葡萄糖酸钙在患者入院时立即进行,生理盐水稀释成1~3%质量浓度,注入到创面皮下脂肪层,一次完成,注入的剂量30~45mg/cm29例,1 0~30mg/cm232例,5~10mg/cm240例。结果:81例均治愈。5例低钙、低镁血症在诊断后4h内得到纠正,75例血钙维持在正常范围,6例出现高钙血症,血钙在皮下注射葡萄糖酸钙后2h达到峰值。结论:静脉结合皮下注射葡萄糖酸钙是救治氢氟酸烧伤的有效方法,葡萄糖酸钙皮下注射后可吸收进入循环,烧伤体表面积较大者如按推荐剂量(50mg/cm2)给药可能超出机体负荷,发生高钙血症。更多还原

【Abstract】 Objective:To evaluate the effectiveness and safety of calcium gluconate by subcutaneous injection and intravenous infusion to treat hydrofluoric acid burns.Methods:Eighty-one patients admitted to our wards from January 2006 to August 2013 were included.The patients’ data as follows:≤ 1%TBSA(15 cases),1~5%TBSA(52 cases),6~10%TBSA(8 cases),11~30%TBSA(5 cases),31~50%TBSA(1 cases);Among these,there were 5 cases with inhalation injury,and 10 cases with ocular injury.For all the patients,the venous pathway was established quickly after admission,and two gram calcium gluconate were administrated by intravenous infusion.For the patients with TBSA ≥ 5%or inhalation injury,calcium gluconate were continued by 0.5 g/h.The level of blood calcium was dynamically monitored.If the blood calcium >2.5 mmol/L,the intravenous infusion was terminated.Results:All 81 patients showed stable situations after treatment using calcium gluconate by subcutaneous injection and intravenous infusion.Five cases,diagnosed as hypocalcemia and/or hypomagnesemia,were corrected immediately in the 4 hours after diagnosis.Six cases showed light hypercalcemia after positive treatment.The other 75 cases were steady in the normal range of blood calcium.There were no obvious adverse effects observed.Conclusions:Subcutaneous injection in combination with intravenous infusion of calcium gluconate can be the alternative method to treat hydrofluoric acid burns.Meanwhile,the topical treatment of HF burns was conducted by subcutaneous injection.Calcium gluconate solution(concentration1%~3%)were injected into the adipose layer under the burned wounds,including 30~45 mg/cm2(9 cases),10~30 mg/cm2(32 cases),5~10 mg/cm2(40 cases).更多还原