| Objective:In this article we analyzed retrospectively of patients with extensive burns in adults(age 18-65 years old)who successfully passed the shock period in our hospital to investigate the amount of fluid replacement,fluid replacement’s speed,crystal fluid,colloid fluid,moisture,and crystal-gel ratio in the four 24-hour period after the injury.And comparing these data with the domestic general formula’s.Analyzing the patient’s consciousness,pulse,respiration,blood pressure,and urine output after injury,and looking for the main factors affecting the first 24-hour fluid replacement.Providing a reference about the first 24-hour fluid replacement and clinical fluid resuscitation to the patients with severe burns.Methods: The number of extensive burns patients(age 18-65 years old)who were eligible for admission during the period from January2010 to October 2019 were treated in our hospital is 61.We recorded the patients’ gender,age,and admission time(from the time of injury to the time of admission to the hospital to establish intravenous infusion),TBSA,Ⅲ ° BSA,cause of injury,presence or absence of shock,andinhalation injury.Calculating the input of crystal fluid,colloid fluid,and water in the first,the second,the third,and the fourth 24 hours after injury.Then we counted the patient’s consciousness,pulse,respiration,systolic blood pressure,diastolic blood pressure,hourly urine volume after admission and treatment.We used SPSS 25.0 and Prism 8.0 software to analyze our data.The measurement data was expressed as mean ±standard deviation(X± S),the counting data was expressed as number of cases and percentage,and the variables between multiple groups were analyzed by ANOVA and LSD-t test.The variables between the two groups were tested by paired sample t test,and the counting data using chi-square test,and when P <0.05 means the analysis was statistically significant.Pearson analysis was performed on gender,age,admission time,TBSA,Ⅲ ° BSA,cause of injury,shock,inhalation injury,and the first 24 hours of fluid replacement volume.Multiple linear regression analysis was performed on analysing continuous variables and total fluid replacement in the first 24 hours after burn.Result:1.The total amount of fluid replacement in the first 24 hours after injury is 6148.05 ± 2470.05 ml which is the highest(P <0.01.).The total amount of fluid replacement in the second 24 hours after injury is2843.44 ± 1352.18 ml,and the total amount of fluid replacement in the third 24 hours after injury is 2412.54 ± 1235.48 ml,and the total amount of fluid replacement in the fourth 24 hours after injury is 2057.33 ±983.05 ml.The ratio of total fluid replacement in the second 24 hours after injury to the total fluid replacement in the first 24 hours after injury(0.47± 0.16)was not statistically significant compared with the general domestic formula ratio(0.50 ± 0.00),P> 0.05.2.The first 8-hour infusion’s rate(401.23 ± 246.02 ml / h)in the first 24 hours after injury is the highest between the second 8-hour infusion rate(203.52 ± 94.96 ml / h)and the third 8-hour infusion rate(162.34 ± 102.11 ml / h)(P <0.05).The average ratio of infusion’s speed was about 10: 5: 4.There was no significant difference between the ratio of the total fluid replacement volume in the first 8 hours and the total fluid replacement volume in the first 16 hours after the injury(0.98 ±0.47),and it is also pointless to the domestic general formula ratio(1.00 ±0.00),P> 0.05.3.In the first 24 hours after burns,the ratio of crystal glue to water input is 2.84 ± 3.57.4.In the first 24 hours after burn,the crystal-gel ratio was 5.24 ±7.52,which was higher than crystal-gel ratio of domestic general formula was 2.00 ± 0.00 the,P <0.01.The time to start colloid input was 4.37 ±2.46 hours after injury.The colloids used 20% human albumin(30%),succinyl gelatin(27%),low molecular dextran(23%),and plasma(15%),Hydroxyethyl starch(5%).Entering 2/5,2/5,1/5 of the total colloid in 3times every 8 hours.5.The total fluid volume in the first 24 hours after burn was positively correlated with TBSA(r = 0.361,P <0.05).The total fluid volume in the first 24 hours after burn was positively correlated with Ⅲ °BSA,(r = 0.493,P <0.05).Y is the first 24 hours of fluid replacement(ml)after burn,X1 is the total burn area(%),and X2 is the third-degree burn area(%).The equation is: Y = 47.45 * X1 + 62.24 *X2 + 2435.98.6.During the treatment,the urine output was 86 ± 56 ml / h,the pulse was 101.21 ± 18.99 beats / min,the breath was 21.66 ± 2.32 beats /min,the systolic pressure was 118.35 ± 17.80 mmHg,and the diastolic pressure was 78.66 ± 9.34 mmHg.Conclusion:1.The first 24-hour total fluid replacement volume was positively correlated with TBSA(r = 0.361,P <0.05)and positively correlated with Ⅲ ° BSA(r = 0.493,P < 0.05).The total fluid volume is increased with the increasing area of total burn and third-degree burn.2.In this study,the total replacement volume(ml)in the first 24 hours after injury in patients(18-65 years old)with extensive burn was47.45X1 + 62.24X2 + 2435.98(X1 is the total burn area,X2 is the third-degree burn area,and the unit of burn area is %).The ratio of crystal gel liquid to water is about 3: 1,and the crystal gel ratio is about 5:1.Entering 2/5,2/5,1/5 of the total colloid in 3 times every 8 hours,and the colloid is mainly composed of 20% human albumin.Half of the fluid replacement amount of the formula calculates is entered within 8 hoursafter the injury,and entering 1/4 of it in 2 times every 8 hours.The amount of fluid replacement in the second 24 hours after injury was half to the volume of fluid replacement in the first 24 hours after injury.3.The mean urine volume of patients(age 18-65 years old)with severe burns in this study was 86 ml / h.4.It is recommended that fluid resuscitation in patients with extensive burn during recovery should be under monitoring closely for more than 3 days. |
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