| Objective:By analyzing the components of fluid rehydration,total fluid rehydration and clinical efficacy in shock phase of children with severe and above burns,explore the strategies of fluid resuscitation in shock phase of children with burns of different ages,and further improve the shock phase of children with extensive burns fluid resuscitation effect and improved prognosis.Methods:The clinical data of 235 children with severe burns admitted to Jiangxi Burn Center from January 1,2015 to June 30,2020 were retrospectively analyzed.After admission,fluid resuscitation was performed.The general conditions of the children were entered.According to the children’s age(0-2,3-6,7-12 years old),The burn area(15～25%TBSA、>25%TBSA),hospital admission time after injury(<3h、≥3h),presence or absence of third-degree burns,etc.were divided into groups,and the actual rehydration coefficient and theoretical rehydration coefficient of each group of children were compared.The total amount of water and liquid is recorded in detail.Calculate the crystal coefficient,the number of gel systems,and the moisture coefficient of the child 8h,the first and second 24h after rehydration.The differences in the amount of fluids in each group of children were compared and analyzed;blood routine indicators,blood biochemical indicators,coagulation indicators,blood gas indicators,etc.were entered when the children were admitted to the hospital and after48 hours of fluid replacement,and then statistically analyzed.Results:General information and treatment:(1)Finally 235 children with burn shock resuscitation were included as the research object,including 150 males and 85females,aged from 3 months to 12 years,with an average of 2.60 years±2.53 years;hospitalization time after injury was 0.5h～5h,with an average of 2.85h±1.28h;the total burn area was 15%～90%TBSA,and the average was 25%±12.10%TBSA.Among them,102 children had deep second-degree burns and 133 children had third-degree burns.,The area of third-degree burns is 1%to 83%TBSA;192 cases of hydrothermal scald among 235 cases,43 cases are flame burns;39 cases have different degrees of shock symptoms on admission.(2)After admission,164 children underwent nasal cannula or mask oxygenation,13 cases underwent tracheotomy due to severe burns and edema of the head,face and neck;all children were not fasted,and 17 cases underwent early enteral nutrition.Component rehydration of the children:(1)The actual volume of liquid replenishment in all children at 8h was greater than the planned volume,and the amount of colloid,water content,and total volume of rehydration were all less than the planned volume,the difference was statistically significant(P<0.01);the actual volume of liquid replenishment in the first and second 24h More than the planned amount,the actual amount of water and the total amount of rehydration were less than the planned amount,the difference was statistically significant(P<0.01),and there was no significant statistical difference between the actual colloid amount and the planned amount(P>0.05).(2)After 8 hours of fluid supplementation,there were 119 children with satisfactory urine output.Compared with children who maintained satisfactory and unsatisfactory urine output,the difference in water coefficient was statistically significant(P<0.05),and there was no significant statistical difference in the crystal coefficient and the number of gel systems(P>0.05)Comparison of fluid rehydration coefficient and curative effect of different burn area groups in different age groups:(1)The actual number of liquid crystal replenishment systems in different TBSA groups of each age group is higher than the theoretical coefficient(P<0.05);7-12 years old 15-25%TBSA actual number of gel systems is less than the theoretical coefficient,The difference is statistically significant(P<0.05),and there is no significant difference between the number of gel systems and the theoretical coefficients in the remaining groups(P>0.05).(2)The crystals and water coefficient of children in the 15-25%TBSA group of 0～2 years old and 3～6 years old were higher than those in the group of more than 25%TBSA,and the difference was statistically significant(P<0.05).The average urine There was no significant difference in the amount and curative effect(P>0.05).(3)There was no significant change in the number of liquid crystal replenishment systems in children aged 7-12years with different burn areas.Children in the 15-25%TBSA group after rehydration in the first 24h water coefficient was significantly higher than that of the 25%TBSA or higher group,and the second 24h glue system was significantly lower In children with more than 25%TBSA,the difference was statistically significant(P<0.01).Comparison of fluid rehydration coefficient and efficacy of different resuscitation times,with or without third-degree burns:(1)Comparing the admission group after injury<3h and the admission group after injury≥3h,there was no significant difference between the first 24h fluid injection coefficient and efficacy(P>0.05).(2)In the third degree burn group,the number of glue system increased and the water coefficient decreased in the first 24h after fluid infusion.The difference was statistically significant(P<0.05),but there was no statistical difference in crystal coefficient and efficacy(P>0.05).Comparison of resuscitation indexes before and after fluid infusion:(1)The average urine output of the first 24h and the second 24h after rehydration were both greater than the average urine output of 8h after the rehydration,the difference was statistically significant(P<0.01).The heart rate at 8h,the first and second 24h after rehydration was lower than that before the rehydration.It was statistically significant(P<0.05),and the rest of the noninvasive indexes were normal,and the difference was not statistically significant(P>0.05).(2)In the curative effect index,Hb,HCT,PLT of blood routine index 48h after rehydration were significantly lower than before rehydration(P<0.01);blood biochemical index 48h after rehydration was significantly lower than that of ALB,ALT,SCr index content before rehydration(P<0.01);There was no statistically significant difference in blood K+,Na+,Cl+content before and after rehydration(P>0.05);PT,APTT,FIB,DD after rehydration 48h in the five indexes of blood coagulation were higher than before rehydration,and TT was less than before rehydration(P<0.01).(5)In the blood gas indexes of children with tracheotomy,blood lactic acid after tracheotomy was lower than before tracheotomy,the difference was statistically significant(P<0.05),and there was no statistically significant difference in PH,Pa O2,Sa O2,Pa CO2,HCO3~-(P>0.05).Prognosis and outcome of children:(1)Of the 235 patients,211 were cured eventually,accounting for 89.79%;5 cases were improved and discharged,accounting for 2.13%,and the remaining few scattered wounds were discharged.It is feasible to change the dressing in the outpatient clinic or local hospital;16 cases were discharged automatically.Accounted for 6.81%,they were discharged from the hospital due to unhealed wounds due to family conditions or cost problems after the shock period passed steadily.3 cases died,accounting for 1.27%.Of all the children,20 had burn-related complications,including 1 stress ulcer,5 gastrointestinal disorders,1pulmonary edema,5 lung infections,12 systemic infections,2 circulatory failures,and respiratory 2 cases of failure.(2)95 children were admitted to hospital after injury<3h,1 died,11 had burn-related complications,including 2 gastrointestinal disorders,6 systemic infections,3 lung infections,and 1 pulmonary edema;after injury≥140cases were admitted at 3 hours,2 cases died,9 cases had burn-related complications,including 6 cases of systemic infection,3 cases of gastrointestinal disorders,1 case of stress ulcer,2 cases of lung infection,2 cases of circulatory failure,and respiratory 2cases of failure.Conclusion1.In order to achieve better resuscitation in shock stage of children with extensive burns,the amount of lens input should be increased and the amount of water reduced,and the amount of crystals and the amount of water can be increased appropriately for younger children than older children;2.Combination Patients with third-degree burns need to increase the amount of colloid input to improve the effect of resuscitation;3.Fluid resuscitation in the shock phase should be based on the age,burn area and depth of the child,and refer to the fluid resuscitation formula to improve various clinical monitoring indicators during shock.Comprehensively judge the effect of resuscitation,and further discuss an effective fluid resuscitation program during the shock period,so that the child can pass the shock period smoothly and improve the prognosis. |
