摘要： 目的探討嚴(yán)重?zé)齻菘似诓煌瑫r(shí)間段體液代謝失調(diào)的變化規(guī)律與防治措施。方法對(duì)1996年1月至2006年12月間住院的169例重度以上燒傷患者休克期不同時(shí)間段的359次的同步血?dú)馀c電解質(zhì)的結(jié)果進(jìn)行回顧性分析。結(jié)果 (1)血清鈉離子在0 h～8 h、8 h～16 h及16 h～24 h時(shí)無顯著性差異,在24 h～48 h及48 h～72 h時(shí)明顯降低,與對(duì)照組比較有極顯著性差異(P<0.01)。(2)血清鉀離子在0 h～8 h、8 h～16 h、24 h～48 h及48 h～72 h時(shí)明顯降低,與對(duì)照組相比較有極顯著性差異(P<0.01),在16 h～24 h時(shí)無顯著性差異。(3)血清碳酸氫根離子在0 h～8 h、8 h～16 h、16 h～24 h、24 h～48 h及48 h～72 h時(shí)明顯降低,與對(duì)照組相比較有極顯著性差異(P<0.01)。(4)血清AG在0 h～8 h、8 h～16 h、16 h～24 h、24 h～48 h及48 h～72 h時(shí)明顯增高,與對(duì)照組相比較有極顯著性差異(P<0.01)。(5)全組患者除82次酸堿失衡類型屬正常外,其余277次中,單純性酸堿失衡類型99次,其中以代謝性酸中毒(代酸)最多;雙重性122次,以呼吸性堿中毒(呼堿)并代謝性堿中毒(代堿)為主;三重性56次,以呼吸性堿中毒并代謝性酸中毒并代謝性堿中毒為主。(6)傷后0 h～8 h、8 h～16 h、16 h～24 h、24 h～48 h和48 h～72 h所發(fā)生的酸堿失衡類型不同,其最多見的類型分別是代謝性酸中毒、呼吸性酸中毒(呼酸)并代謝性酸中毒、呼吸性酸中毒、呼吸性堿中毒和呼吸性堿中毒并代謝性堿中毒。結(jié)論嚴(yán)重?zé)齻菘似诓煌瑫r(shí)間段的電解質(zhì)的結(jié)果有差異,血清鈉離子在48h以后明顯降低,血清鉀離子在16 h～24 h時(shí)間段正常,其他時(shí)間段明顯降低。血清HCO_3~-與血清AG呈負(fù)相關(guān),燒傷休克期代謝性酸中毒為高AG性代謝性酸中毒。嚴(yán)重?zé)齻菘似诓煌瑫r(shí)間段的酸堿失衡類型比較復(fù)雜,燒傷后24 h內(nèi)以酸中毒為主,24 h后以堿中毒為主,三重性酸堿失衡發(fā)生率不低,傷后0 h～8 h以呼酸型三重性酸堿失衡為主,48 h后以呼堿型三重性酸堿失衡為主。 Objective To explore the pattern of change and preventive measures of fluid and electrolyte imbalance in different periods of shock stage of severe burn.Methods Retrospective review the result of electrolyte and 359 times synchronized blood gas analysis in different periods of shock stage of 169 severe patients,admitted from Jan 1996 to Dec 2006.Results(1 )The serum Na~+ value had no significant difference between the treatment group and control group al 0 h～8 h,8 h～16 h,and 16 h～24 h.But it decreased at 24 h～48 h and 48 h～72 h with significant difference(P<0.01 ).(2 ) The serum K~+ value of the treatment groups was reduced significantly al 0 h～8 h,8 h～16 h,24 h～48 h, and 48 h～72 h,with very significant difference(P<0.01 ) compared with the control group,But no significant difference was seen between 16 h～24 h.(3) The serum HCO_3~- value of treatment groups was reduced significantly at 0 h～8 h, 8h～16h,16h～24h,24h～48h,and 48 h～72 h,with very significant difference(P<0.01 ) compared with control groups.(4) The serum AG value of treatment groups was significantly high at 0h～8h,8h～16h,16 h～24 h, 24 h～48 h,and 48 h～72 h,with very significant difference(P<0.01 ) compared with the control group.(5) Among the group 82 cases of acid-base imbalance was normal,99 out of the rest 277 had simple acid-base imbalance,most of which had metabolic acidosis.122 cases had double acid-base imbalance,most of them had mixed respiratory alkalosis and metabolic alkalosis.56 cases had triple acid-base imbalance,most of them had mixed respiratory alkalosis and metabolic acidosis and metabolic alkalosis.(6) Different types of acid-base imbalance were seen at 0～8h,8～16h,16～24 h, 24～48 h and 48～72 h,and the most common ones are metabolic acidosis,mixed respiratory acidosis with metabolic acidosis, respiratory acidosis,respiratory alkalosis and mixed respiratory alkalosis and metabolic alkalosis respectively.Conclusion Value of electrolytes has significant differences at different phases of shock stage of severe bum.The serum Na~+ value is decreased significantly after 48 h.The serum K~+ value is remained normal at 16 h～24 h,but decreases obviously in other periods.The serum HCO_3~- value is in a negative correlation with that of serum AG value.Metabolic acidosis of shock stage is all high AG metabolic acidosis.Types of acid—base imbalance are complex at shock stage of sever burn,acidosis is more common within 24 hours after burn,but alkalosis is more common after 24 h;incidence of triple acid-base imbalance is high and respiratory acidosis type of triple acid-base imbalance is more common at 0 h～8 h,but 48 h after burn,respiratory alkalosis type of acid-base imbalance is more common.
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