Clinical Analysis Of Resuscitation Fluid Rehydration During Burn Shock In Children

Objective:To summarize and explore the resuscitation and fluid rehydration program in pediatric burn shock period and to share the experience based on the successful resuscitation cases in the shock period in our hospital in recent years.Methods:A retrospective review was made of 74 pediatric burn patients aged 0 to 7years with burn area ≥5% who were admitted to the Department of Burns and Orthopaedics of the First Hospital of Hebei Medical University from January2014 to December 2016.Children after admission were admitted to our department and intensive care unit,gave comprehensive ECG monitoring,oxygen,intravenous fluids,anti-infection,monitored of vital signs and Detailed record of 24 hours in and out,gave the wound debridement and bandage,according to the depth of the wound timely determined conservative or surgical treatment,in order to make them smoothly through the shock stage and discharged from hospital after wound healing.The fluid volume and quality in shock period was adjusted according to the mental state,urine volume and vital signs of the children,and then the fluid volume(intravenous fluid volume and oral fluid volume),urine volume,heart rate,respiratory rate and mean length of hospital stay of each child in shock period were statistically analyzed.Chi-square test was used for counting data,and t test or rank sum test was used for measurement data.P < 0.05 indicated statistically significant difference.Results: In the study group,the amount of colloidal and crystals input in the first 24 hours after injury=burn area(%TBSA)× body weight(kg)×(4.77±4.10)ml,the amount of colloidal input = burn area(%TBSA)× body weight(kg)×(1.26±1.13)ml,the amount of crystal = burn area(%TBSA)×body weight(kg)×(3.51±1.98)ml,and water was(67.49±34.05)% of the basic requirement.The actual fluid volume in the first 8 hours after injury was(71.59±28.68)% of the theoretical value,was(35.18±24.41)% of the actual and(35.79±14.34)% of the theoretical fluid volume in the first 24 hours.In the second 24 hours after injury,the total amount of crystal and determined was(67.36±29.66)%,crystal amount was(73.14±34.98)%,and colloidal amount was(57.16±63.97)% of the first 24 hours.The actual water supplementation was(74.19±29.93)% of the daily basic requirement.The volume of oral liquid at the first 24 hours after injury was(28.87±26.92)m L/kg,accounting for(15.96±13.63)% of the total amount of liquid.The volume of oral liquid at the second 24 hours after injury was(47.55±33.39)m L /kg,accounting for(29.62±17.99)% of the total amount of liquid.After fluid rehydration,all children passed the shock phase smoothly without any clinical complications,and the average urine volume was greater than 1ml/kg/h.In addition,the heart rate and respiratory rate of all the children tended to be stable without large fluctuations,and the hospitalization time of the children with different burn severity was not prolonged.Conclusions:1.After rehydration,all children survived the shock phase smoothly,and there were no complications of respiratory system,digestive system and circulatory system.In addition,the hospitalization time of the children with different burn severity was not prolonged,which had no effect on the prognosis.Therefore,individualized rehydration regimen should be implemented according to the specific conditions of each child,instead of blindly following the formula.2.For pediatric burn patients,fluid rehydration during shock period can be carried out according to the following formula:The amount of crystal and colloid in the first 24 hours after injury = burn area(%TBSA)×body weight(kg)×(4.77±4.10)ml,the amount of colloid in the first 24 hours after injury = burn area(%TBSA)× body weight(kg)×(1.26±1.13)ml,crystal volume = burn area(%TBSA)× body weight(kg)×(3.51±1.98)ml,and water was(67.49±34.05)% of the basic requirement.The fluid volume in the first 8 hours after injury was(71.59±28.68)% of the theoretical fluid volume and(35.18±24.41)% of the actual fluid volume in the first 24 hours.The total amount of crystal and colloid in the second 24 hours after injury was(67.36±29.66)% of that in the first 24 hours,the crystal amount was(73.14±34.98)% of the first 24 hours,the colloid content was(57.16±63.97)%of the first 24 hours,and the moisture content was(74.19±29.93)% of the daily basic requirement.The volume of oral liquid in the first 24 hours after injury accounted for(17.69±16.62)% of the total theoretical liquid,and the volume of oral liquid in the second 24 hours after injury accounted for(28.46±20.69)%.3.Children with poor compliance,in order to meet the taste needs of children,part of the liquid can be given to children orally.Oral administration was performed at(28.87±26.92)ml /kg and(47.55±33.39)ml /kg at the first and second 24 hours after injury.With the increase of age,oral intake per kilogram of body weight tended to decrease,and the proportion of oral intake to total liquid intake also decreased gradually.