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大面积烧伤休克期补液复苏的经验
早期及时有效地补液,是成功救治大面积烧伤伤员的关键.关于烧伤后早期的输液的成分、速度、次序,中外专家提供了许多有效的公式可供参考,各临床医师也有自己的临床经验.
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输血反应致癫痫持续状态1例
病例介绍:患者,男性,23岁,于1996年5月初,洗澡时不慎滑入开水池中约3 min,伤后4h急诊入院.入院时检查:神志淡薄,精神萎糜,体温36℃,呼吸34次/min,心率140次/min四肢厥冷,足背动脉不能触及,全身除头部发际外均被烫伤.诊断:全身烫伤97%(其中三度52%)伴低血容量性休克.入院后立即静脉切开插管快速补液复苏,因颈部肿胀行气管切开,第一个24h总补液量为8 300ml,尿量维持在90 ml/h,10h后休克症状缓解,即行清创,暴露疗法.
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救治烧伤后并发非结石性胆囊炎一例
患者男,33岁,火焰烧伤全身多处,伤后1 h入院.诊断:烧伤总面积82%,其中浅Ⅱ度15%、深Ⅱ度24%、Ⅲ度43%TBSA.既往无慢性病史.入院后给予补液复苏及抗感染治疗,同时静脉滴注西米替丁0.4 g,3次/d,创面外用磺胺嘧啶银.休克期度过平稳,因家属不同意,未行早期切痂植皮术.
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治愈严重电烧伤合并Ⅱ型糖尿病二例
例1,患者男,36岁.触及10 kV高压电,致颈部、头部、左手及右足电烧伤.伤后昏迷半小时,送当地医院经补液复苏等治疗,于4 d后转送本院.查体:体温37.4℃,脉搏80次/min,呼吸20次/min,血压130/80 mmHg(1 mmHg=0.133kPa).口角歪斜,张口时下颌偏向左侧,左颞顶部及左颈部为黑色焦痂,颅骨外露4 cm×6 cm.左颈部肿胀明显,创面约8 cm×13 cm,周围红肿,左颈总动脉搏动不能触及.左手虎口处创面3 cm×3 cm,深达肌肉.右足第4、5趾炭化、趾骨外露,第5趾骨远端缺损,第3趾骨部分外露.空腹血糖11.6 mmol/L,接连两天复查血糖,结果均显著高于正常水平,0GTT试验和胰岛素释放试验结果提示为Ⅱ型糖尿病.
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烧伤液体复苏及其监测研究进展
Shock is the one of the most serious complications during the early stage of burn injury.Early effective fluid resuscitation,enabling the burn patient to pass through the shock stage smoothly and uneventfully,plays a necessary and essential role in the prevention of the subsequent organ complications,reduction of mortality and morbidity,and improvement in life quality.Rapid restoration of blood volume is the fundamental measure to prevent burn shock.In this review,the history and the current status of several important issues related to burn shock resuscitation,including the fluid replacement formula,quality of fluids,and monitoring of physiological parameters,were overviewed.The authors also proposed that a new therapeutic strategy to prevent microvascular permeability should be emphasized and developed in future,which may hopefully act as the most basic approach to prevent burn shock and its related complications.
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重度烧伤后早期并发腹腔间隙综合征与胸腔积液三例
例1 男,45岁,体质量65 kg,被鞭炮炸伤后7 h入院.诊断:(1)火药烧伤50%TBSA,深Ⅱ度.(2)低血容量性休克.(3)吸人性损伤.入院后立即给予补液复苏、气管切开、抗感染、保护内脏功能、简单清创等处理.