| Due to the changes in pathophysiology during early stage of extensive burn,leaded to a high incidence of complications,and the highest complication is pulmonary edema.Pulmonary edema is an important inducement of pulmonary infection,acute respiratory distress syndrome(ARDS)or respiratory dysfunction,which can cause multiple organ failure(MODS)even death,it has an important effect on the outcome of patients with extensive burn.Traditional pulmonary edema monitoring methods can not accurately measure the extravascular lung water content,and the operation was complex,low clinical practicality,so that the monitoring and prevention of lung water of extensive burn was limited.Some studies showned that extravascular lung water content was positively correlated with pulmonary edema,and the extent of pulmonary edema can be quantified by extravascular lung water content.Pulse index continuous cardiac output(PICCO)capacity monitor can monitor the volume of extravascular lung water in the bedside,which is the only technique to monitor the pulmonary water content at present.In the early stage of our team,used PICCO continuous monitoring and serendipity found the prevalence of extravascular pulmonary edema(ELWI)in extensive burns(3-10 days after injury),and were higher than normal(7 mL / kg),indicated that the present treatment mode can cause different degrees of pulmonary edema in the early stage of extensive burns.Further analysis showed that lung function in the early stage of extensive burns was significantly negatively correlated with ELWI.The above studies revealed the changes of early pulmonary water in extensive burns and its possible clinical significance.Restricted liquid management strategy(RFMS)refers to the body maintain a period time of the body fluid negative balance,limiting the amount of liquid input,increasing the amount of liquid discharge.A number of studies have improved RFMS can significantly improve lung function and prognosis of acute lung injury(ALI),infection,ARDS and shock patients.So that,we speculated that RFMS can reduce the capacity of lungs,improve lung oxygenation,reduce lung complications and improve the prognosis.This study was designed to investigate the role of RFMS in the regulation of early body fluid balance,control pulmonary water abnormal and prevent pulmonary complications in extensive burns by RFMS and conventional fluid management in extensive burns in back to absorb period,for extensive burns with early precision monitoring,prevent and cure pulmonary edema to provide the basis.MethodsUsed nonrandom prospective observational study,passed the southwest hospital ethical review committee for examination and approval,then signed the consent form after obtaining agreement.Thirty-two patients with severe burn hospitalized from June 2012 to December 2014,being treated with normal fluid therapy in fluid reabsorption stage,were enrolled as control group(CG);Twenty-nine patients with severe burn hospitalized from January 2015 to July 2016,being treated with RFMS in fluid reabsorption stage,were enrolled as treatment group(TG).Used Pulse indicator Continuous Cardiac Output(PICCO)to monitor and record Hemodynamic indexes(ELWI、PVPI、dPmx、MAP、GEDI、ITBI、SVRI)of 2 groups in back to absorb period.Fluid intake,fluid output,daily fluid net balance,daily fluid cumulative net balance,the biochemical test results of the laboratory,pathogenic bacteria culture results and the usage of breathing machine in back to absorb period were recorded and compared.The incidence of ARDS and pulmonary infection within 2 weeks post burn and Lung infection、Blood infection and other organs complications were recorded and compared.Analyzed mortality and exacerbation of 2 groups and compared within 4 weeks.Results1.Demographic information introductionThere were no significant differences in age,sex,height,weight,time of admission,classification of burns,inhalation injury and wound size between two groups(P> 0.05).2.In back to absorb period the impact of RFMS on the body fluid balanceThe net balance of daily liquid in the two groups was decreased in back to absorb period,TG was lower than CG at each time point,at 6th day,there was significant difference between two groups(P <0.05).The net balance of the accumulated fluid in the two groups was increased,and TG was always lower than CG,and the P value of each time point was less than 0.05.The albumin treatment group was slightly higher than control group in back to absorb period,and Serum potassium(K)、 serum sodium(Na)and other electrolyte concentrations in both groups were in the normal range.3.In back to absorb period the impact of RFMS on hemodynamicsGEDI and ITBI were gradually increased of two groups in back to absorb period,and reached the peak on the 7th day after injury.After that,the GEDI and ITBI decreased,and reached the lower limit of the normal range on the 10 th day after injury.The GEDI and ITBI of TG continued to be in a high level on day 7-10 after injury,close to or slightly above normal.There was significant difference GEDI between the two groups(P <0.05)at day 4、10 after injury.The ITBI difference between the two groups was statistically significant(P <0.05)at day 10 after injury.The CI in the two groups was gradually increased,and the 4-10 days were higher than the normal upper limit,all reached the peak on the 6th day,then decreased slightly,TG decline more obvious.There were no significant differences in MAP and SVI between the two groups and all in the normal range.The dpmx of TG was slightly higher than CG from day4 to10 after injury.The SVRI in TG was slightly higher than CG from the end of shock to the 7th day after injury.4.In back to absorb period the impact of RFMS on ELWI and OIThe level of ELWI in CG was higher than TG,and TG was higher than the normal upper limit at 7-9 days after injury,the difference was statistically significant(P <0.05)at day 4 after injury.The total number of ELWI abnormalities in the two groups was: the TG was 82,the CG was 134;the proportion of ELWI abnormal days was 35.3% and 52.3%,respectively.There was significant difference between the two groups(P <0.01).OI in both groups showed a decreasing trend in back to absorb period,and the decrease was more obvious in CG,CG at 3-8 days after injury was lower than TG.5.In back to absorb period the impact of RFMS on ventilator use and lung complicationsThe use of ventilator in back to absorb period was 15 cases in CG and 6 cases in TG.There was significant difference between the two groups(P<0.05).The total number of days used ventilator in CG was 105 days,accounting for 41.02% of the total number of days of recovery,per capita 3.28 days.The total number of days used ventilator in TG was 43 days,18.53% of the total number of days,(P = 0.00 <0.01).There were 12 cases of ARDS in CG and 4cases in TG within 2 weeks after injury.There were 14 cases of lung infection in CG an 5 cases in TG.There was significant difference between the two groups(P <0.05).6.In back to absorb period the impact of RFMS on blood infection,other organ complications and deathWithin 2 weeks after injury,the incidence of blood infection was 6 cases in TG and 18 cases in CG.There was significant difference between the two groups(P <0.05).After 2weeks of injury,6 cases occurred 4 other organ complications in TG.In CG,15 cases occurred 8 other organ complications.The P value was less than 0.05,the difference was statistically significant.Within 4 weeks after injury,1 case died in TG,9 cases were exacerbated,7 cases died in CG and 15 cases were exacerbated,the differences of the 2 indicators were significantly(p<0.05).Conclusion1.In back to absorb period RFMS can effectively reduce the net balance of daily liquid and net balance of the accumulated fluid of extensive burns,to a certain extent improve plasma protein content,no significant impact on the electrolyte concentration.2.In back to absorb period RFMS can effectively control the increase of capacity in extensive burns,to a certain extent to enhance heart function,other hemodynamic indicators have no adverse effects.3.In back to absorb period RFMS can effectively prevent the increase of ELWI in extensive burns,improve lung oxygenation function in some extent,reduce the use of ventilator,reduce lung infection、ARDS and other lung complications.4.In back to absorb period RFMS can reduce the incidence of other organs and the occurrence of bloodstream infection in extensive burns,reduce the deterioration of the disease and reduce the mortality rate,which has great significance to improve the prognosis of large area burns. |
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