急重症烧伤休克的病理改变与液体复苏.pptxVIP

急重症烧伤休克的病理改变与液体复苏;烧伤及烧伤休克概述;什么是烧伤？;;; 血容量减少 毛细血管通透性改变 血浆渗透压降低加重血浆成分外渗 钠离子与水分同步丢失 创面水分蒸发导致血容量减少;毛细血管通透性改变;血浆渗透压降低加重血浆成分外渗;钠离子与水分同步丢失;创面水分蒸发导致血容量减少;热 力 损 伤;;烧伤及烧伤休克概述;液体的两种观点 ;retrospective study ;延迟复苏对烧伤患者组织器官损伤严重;目标导向的容量管理是发展趋势;液体治疗的关键是目标导向，目标导向的前提是监测方法;无创循环检测指标;复苏目标(EGDT);EGDT在烧伤休克的应用1;EGDT在烧伤休克的应用1;EGDT在烧伤休克的应用1;快速充分的液体复苏;快速充分的液体复苏;复苏原则;烧伤面积超过20％～25％总体表面积(TBsA)者多伴发毛细血管通透性增加和血容量不足 其改变以伤后第一个24 h尤为明显 恰当液体复苏的目的是用最少的液体量和最小的生理代价支持器官灌注 液体复苏不足会导致血流灌注减少，出现急性肾功能衰竭(ARF)，甚至死亡;;;烧伤及烧伤休克概述;; 伤后早期有血液浓缩的问题，不宜输血； 开始复苏时宜尽快输入电解质、水分及血浆等胶体。 大面积严重烧伤需输血，伤后6-8h血浓缩减轻后再输全血。 病原体传播：HCV、HBV、 HIV ;白蛋白1;白蛋白1;胶体液复苏;胶体液复苏;胶体液复苏;胶体与晶体;;Albumin or plasma protein fraction - 24 trials reported data on mortality, including a total of 9920 patients. The pooled risk ratio (RR) was 1.01 (95% CI 0.93 to 1.10). Excluded the trial with poor-quality allocation concealment, pooled RR was 1.00 (95% CI 0.92 to 1.09). Hydroxyethyl starch - 25 trials compared hydroxyethyl starch with crystalloids and included 9147 patients. The pooled RR was 1.10 (95% CI 1.02 to 1.19). Modified gelatin - 11 trials compared modified gelatin with crystalloid and included 506 patients. The pooled RR was 0.91 (95% CI 0.49 to 1.72). (When the trials by Boldt et al were removed from the three preceding analyses, the results were unchanged.) Dextran - nine trials compared dextran with a crystalloid and included 834 patients. The pooled RR was 1.24 (95% CI 0.94 to 1.65). Colloids in hypertonic crystalloid compared to isotonic crystalloid Nine trials compared dextran in hypertonic crystalloid with isotonic crystalloid, including 1985 randomised participants. Pooled RR for mortality was 0.91 (95% CI 0.71 to 1.06).;conclusions There is no evidence that resuscitation with colloids reduces the risk of death, compared to resuscitation with crystalloids, in patients with trauma, burns or following surgery. Furthermore, the use of hydroxyethyl starch might increase mortality. As colloids are not associated with an improvement in survival