| Burns can cause shock more easily in children than in adults, which is attributed to the physiological characteristics. Commonly, if TBSA is beyond 10%, shock probably occur. Fluid resuscitation is an important way to prevent shock, decrease the mobidity of shock, protect the function of important organs, prevent sepsis, and decrease the morbidity of most common viscus syndrome. Hyponatremia is common compliance with fluid resuscitation, which is the main cause of seizures, tics, even death in burned children. There are many ways to prevent burned children from hyponatremia, such as infusing enough sodium, or avoiding to excessive use of hypotonic fluids, applying diuretics properly, et al. To explore a resuscitation strategy preventing hyponatremia, retrospective study and prospective experiments were employed to investigate the influence of infusing daily sodium requirements during fluid resuscitation on the homeostasis of electrolytes and morbidity of hyponatremia.Methods:The study was divided into two parts: Retrospective study and prospective experiments. First, 198 cases of burned children admitted in the Department of Burns in Southwest Hospital were reviewed. The general data(age,sex,TBSA caused of burns), details of fluid resuscitation, signs of life and laboratory results were statistically analyzed. Second,clinical prospective study, the children with 10~30% TBSA admitted within 8 hours after burns were divided into two groups randomly. In the control group, the sodium according to the Third Military Medical University(TMMU) formula were given. The trial group, besides the sodium according to the formula, the daily sodium requirements were added. The details of fluid resuscitation, signs of life, labs results and incidence of hyponatreima were compared statistically.Results:Retrospective Part:1. There were two types of fluid resuscitation in 198 cases of burned children.129 cases(65.1%) adopted TMMU formula of fluid resuscitation. And 69 cases(34.9%) were infused sodium beyond TMMU formula, named sodium-added group.The mean amount of added sodium was 2.52±0.5mmol/(kg.d), which was in the range of daily sodium requirements for children. 2. There were no significant difference in the total amount of fluid between two groups during the resuscitation (P>0.05). But the amount of urine of sodium-added group was significantly larger than the general group(P<0.05).3. During the same period, the concentration of serum sodium of sodium-added group was higher than the control group significantly(P<0.01).And it showed lower morbidity of hyponatremia than the control group(P<0.05).4.When TBSA between 10% and 29%, the morbidity of hyponatremia was lower in the sodium-added group than the counterpart(P<0.05). But there were no significant difference between two groups when TBSA ranged from 30% to 50%(P>0.05).Prospective Part:1. Between two groups, there were no significant difference in general aspects such as age, sex, TBSA, et al. 2.There was no significant difference in the total amount of infused-fluid between two groups during the resuscitation(P>0.05). But the amount of urine of daily-required sodium group was significantly larger than the general group(P<0.05).3. signs of life such as temperature, pulse, ABP and time of respiratory were almost the same in both groups. (P>0.05)4. The concentration of serum sodium and chloride in the trial group was significantly higher than the general group after 1 to 3 of PBD.(P<0.01). No case had happened ,in which the concentration of serum sodium and chloride were beyond the high limit. There were no significant difference in the other indexes such as WBC, RBC, NEUT%, PLT, HGB, GPT, GOT, et al. (P>0.05)5. The morbidity of hyponatremia in experiment group was 6.3%,and the control group was 25%.Conclusions:Supplementing dialy sodium requirements and TMMU formula sodium during fluid resuscitation in burned children can increase the concentration of serum sodium, and decrease the morbidity of hyponatremia, which is benefitial for the therap... |
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