回吸收期RFMS防治大面積燒傷肺臟并發(fā)癥的臨床研究
發(fā)布時(shí)間：2018-07-15 17:04
【摘要】：背景及目的大面積燒傷患者早期由于身體各器官病理生理的改變,并發(fā)癥多,而肺臟并發(fā)癥發(fā)生率最高。大面積燒傷早期易發(fā)生肺水腫,肺水腫是肺部感染、急性呼吸窘迫綜合征(ARDS)或呼吸功能障礙等的重要誘因,可致患者多器官功能衰竭(MODS)甚至死亡,對大面積燒傷患者的轉(zhuǎn)歸和預(yù)后有重要影響。傳統(tǒng)的肺水監(jiān)測方法不能準(zhǔn)確測量血管外肺水含量,且操作復(fù)雜,臨床實(shí)用性不高,使大面積燒傷患者早期肺水的監(jiān)測和防治受限。有研究指出血管外肺水含量與肺水腫成正相關(guān),肺水腫的程度可以通過血管外肺水含量來量化[1]。脈搏輪廓持續(xù)心輸出量(pulse indicator continuous cardiac output,PICCO)容量監(jiān)測儀可床旁定量監(jiān)測患者血管外肺水含量,是目前能床旁動(dòng)態(tài)定量監(jiān)測肺水含量的唯一新技術(shù)。課題組前期采用PICCO連續(xù)監(jiān)測意外發(fā)現(xiàn),大面積燒傷患者進(jìn)入回吸收期(傷后3-10天),血管外肺水腫指數(shù)(ELWI)呈持續(xù)性增高的狀態(tài),且均高于正常高值(7mL/kg),說明在現(xiàn)有的治療模式下大面積燒傷早期均存在不同程度的肺水腫。進(jìn)一步分析,發(fā)現(xiàn)大面積燒傷早期肺功能與ELWI呈顯著負(fù)相關(guān)。上述研究揭示了大面積燒傷患者早期肺水變化規(guī)律及其可能臨床意義。限制性液體管理策略(restrictive fluid management strategy,RFMS)是指為了使機(jī)體保持一段時(shí)間的體液負(fù)平衡,在限制液體輸入量,增加液體排出量[2]。多項(xiàng)研究顯RFMS能明顯改善急性肺損傷(ALI)、感染、ARDS、休克患者的肺功能及預(yù)后[3][4][5],但在燒傷領(lǐng)域未見相關(guān)研究。就此我們推測對處回吸收期大面積燒傷患者行RFMS,可減輕容負(fù)擔(dān),降低肺水含量,改善肺臟氧合功能,減少肺臟并發(fā)癥以及改善預(yù)后。本研究擬通過對回吸收期大面積燒傷患者采用RFMS和常規(guī)液體管理,在PICCO監(jiān)測的基礎(chǔ)上等明確RFMS在調(diào)節(jié)大面積燒傷患者早期體液平衡,控制肺水異常及防治肺臟并發(fā)癥方面的作用,為大面積燒傷患者早期精準(zhǔn)監(jiān)測、防治肺水腫提供依據(jù)。對象與方法采取非隨機(jī)的前瞻性研究方法,通過了西南醫(yī)院倫理審查委員會(huì)的審批,患者均簽署知情同意書。對照組收集2012年6月-2014年12月入住西南醫(yī)院燒傷科的32例大面積燒傷患者,限制組收集2015年1月-2016年7月入住西南醫(yī)院燒傷科的29例大面積燒傷患者。兩組休克期(傷后2天)治療方法相同,回吸收期對照組常規(guī)治療,限制組實(shí)施RFMS,即適當(dāng)控制補(bǔ)液總量+通過利尿促進(jìn)體液排出(定時(shí)定量靜推速尿,5mg/次,4-6次/日,總量20-30mg/日)。采用PICCO監(jiān)測儀連續(xù)監(jiān)測兩組患者回吸收期血流動(dòng)力學(xué)指標(biāo)(ELWI、肺血管通透性指數(shù)PVPI、每搏輸出量指數(shù)SVI、心臟指數(shù)CI、左心室收縮力指數(shù)dpmx、平均動(dòng)脈壓MAP、全心舒張末期容積指數(shù)GEDI、胸腔內(nèi)血容積指數(shù)ITBI、全身外周血管阻力指數(shù)SVRI);經(jīng)管護(hù)士記錄兩組患者每日液體出入量,并計(jì)算出每日液體凈平衡和每日累積液體凈平衡;記錄兩組患者每日常規(guī)生化檢查、細(xì)菌培養(yǎng)結(jié)果。記錄兩組患者回吸收期使用呼吸機(jī)的情況,傷后2周內(nèi)ARDS、肺部感染和血液感染的發(fā)生率,2周內(nèi)其他臟器并發(fā)癥的發(fā)生情況以及傷后4周內(nèi)病情惡化及死亡的例數(shù)。SPSS22.0行統(tǒng)計(jì)分析,連續(xù)性數(shù)據(jù)采用均數(shù)±標(biāo)準(zhǔn)差,計(jì)量資料采用獨(dú)立樣本t檢驗(yàn)、重復(fù)測量,計(jì)數(shù)資料采用χ2檢驗(yàn)等統(tǒng)計(jì)方法;檢驗(yàn)水準(zhǔn)α=0.05。結(jié)果1.人口統(tǒng)計(jì)學(xué)資料介紹兩組患者在年齡、性別、身高、體重、入院時(shí)間差、燒傷原因分類、吸入性損傷及創(chuàng)面大小等方面進(jìn)行比較,均無統(tǒng)計(jì)學(xué)差異(P0.05),具有可比性。2.回吸收期RFMS對液體平衡的影響回吸收期兩組患者每日液體凈平衡呈下降趨勢,限制組各時(shí)間點(diǎn)均低于對照組,且第6天差異有統(tǒng)計(jì)學(xué)意義(P0.05);回吸收期兩組患者回每日累積液體凈平衡呈上升趨勢,而限制組始終低于對照組,且各時(shí)間點(diǎn)P值均小于0.05;回吸收期限制組蛋白略高于對照組,血鉀(K)、血鈉(Na)等電解質(zhì)濃度兩組均處于正常水平范圍。3.回吸收期RFMS對血流動(dòng)力學(xué)的影響進(jìn)入回吸收期后,兩組患者GEDI和ITBI都逐步上升,于傷后第7天達(dá)高峰;之后限制組GEDI和ITBI呈下降趨勢,至傷后第10天達(dá)正常范圍下限,而對照組GEDI和ITBI在傷后第7-10天呈持續(xù)高水平狀態(tài),接近或略超正常值上限。兩組GEDI在傷后第4、10天差異有統(tǒng)計(jì)學(xué)意義,ITBI在傷后第10天有差異有統(tǒng)計(jì)學(xué)意義(P0.05)�；匚掌趦山M患者CI都逐步上升,第4-10天均高于正常上限,均在第6天達(dá)峰值,隨后略逐漸下降,限制組降幅更明顯�；匚掌趦山M患者M(jìn)AP和SVI均在正常范圍,二者比較無統(tǒng)計(jì)學(xué)差異。限制組心肌收縮指標(biāo)dpmx于傷后第4-10天略高于對照組;限制組SVRI從休克期末至傷后第7天略高于對照組。4.回吸收期RFMS對兩組患者ELWI和OI的影響回吸收期對照組ELWI均高于正常值上限,限制組僅在傷后7-9天高于正常值上限,且回吸收期對照組均高于限制組,第4天組間差異有統(tǒng)計(jì)學(xué)意義(P0.05)�；匚掌趦山M患者出現(xiàn)ELWI異常的總天數(shù)分別為:限制組82天,對照組134天;ELWI異常天數(shù)的比例分別為35.3%和52.3%,二者比較具有統(tǒng)計(jì)學(xué)差異(P0.01)。兩組患者回吸收期OI均表現(xiàn)出下降趨勢,以對照組降幅更為明顯,限制組傷后第3-8天高于對照組。5.回吸收期RFMS呼吸機(jī)使用和肺臟并發(fā)癥的影響回吸收期呼吸機(jī)使用情況為對照組15例,限制組6例,二者具有顯著差異(P=0.030.05)。對照組呼吸機(jī)使用總天數(shù)為105天,占回吸收期總天數(shù)的41.02%,人均3.28天;限制組呼吸機(jī)使用總天數(shù)43天,占回吸收期總天數(shù)的18.53%,人均1.48天,二者比較具有顯著差異(P=0.000.01)。傷后2周內(nèi)限制組4例發(fā)生ARDS,對照組12例;限制組5例發(fā)生肺部感染,對照組14例;二者比較均有統(tǒng)計(jì)學(xué)差異(P0.05)。6.回吸收期RFMS對血液感染、其他臟器并發(fā)癥與死亡情況的影響傷后2周內(nèi),血液感染發(fā)生情況為限制組6例,對照組18例,組間比較P值小于0.05。傷后2周內(nèi),限制組6例發(fā)生其他4種臟器并發(fā)癥,對照組15例發(fā)生其他8種臟器并發(fā)癥,P值小于0.05,差異有統(tǒng)計(jì)學(xué)意義。傷后4周內(nèi),限制組1例死亡,9例病情惡化,對照組7例死亡,15例病情惡化,二者比較P值均小于0.05,差異均有統(tǒng)計(jì)學(xué)意義。結(jié)論1.回吸收期RFMS可有效減少大面積燒傷每日液體凈平和累計(jì)液體凈平衡,一定程度提高血漿蛋白含量,對電解質(zhì)濃度未見明顯影響。2.回吸收期RFMS可有效控制大面積燒傷容量增加,一定程度提升心臟功能,對其他血流動(dòng)力學(xué)指標(biāo)未見不良影響。3.回吸收期RFMS可有效預(yù)防大面積燒傷患者ELWI異常升高,一定程度改善肺氧合功能,減少呼吸機(jī)使用,降低肺部感染和ARDS等肺臟并發(fā)癥。4.回吸收期RFMS可減少大面積燒傷早期其他臟器并發(fā)癥和血流感染的發(fā)生,減少病情惡化,降低死亡率,對改善大面積燒傷預(yù)后具有積極意義。
[Abstract]:Background and objective large area burns patients have many complications, and the incidence of lung complications is the highest. Pulmonary edema is easy to occur in the early stage of large area burns, pulmonary edema is pulmonary infection, acute respiratory distress syndrome (ARDS) or respiratory dysfunction can cause multiple organ function in patients with large area burns. Failure (MODS) or even death has an important influence on the prognosis and prognosis of patients with large area burns. The traditional pulmonary water monitoring method can not accurately measure the content of the extravascular lung water, and the operation is complex and the clinical practicability is not high. The monitoring and prevention of early pulmonary water in the patients with large area burns is limited. There is a positive correlation. The degree of pulmonary edema can be quantified by pulse indicator continuous cardiac output (PICCO) capacity monitor by the content of the extravascular lung water (indicator continuous cardiac output, PICCO). The quantitative monitoring of the content of extravascular pulmonary water in patients with the bed side of the bed is the only new technique for the quantitative monitoring of the content of the lung water by the dynamic side of the bed. With PICCO continuous monitoring, patients with large area burns entered the reabsorption period (3-10 days after injury), and the extravascular pulmonary edema index (ELWI) showed a continuous increase, which was higher than the normal high value (7mL/kg). It showed that there were different degrees of pulmonary edema in the early stage of large area burn. The early lung function of area burns was negatively correlated with ELWI. The above study revealed the early changes in the lung water and its possible clinical significance. The restrictive liquid management strategy (restrictive fluid management strategy, RFMS) means to keep the body fluid negative balance for a period of time and limit the amount of liquid input, A number of [2]. studies show that RFMS can obviously improve the lung function and prognosis of acute lung injury (ALI), infection, ARDS, shock, and [3][4][5], but there is no related research in the field of burn. Therefore, we speculate that RFMS can reduce the burden, reduce the content of lung water and improve the oxygenation function of the patients with large area burns at the reabsorption period. To reduce the lung complications and improve the prognosis. The purpose of this study is to use RFMS and conventional liquid management for patients with large area burns in the reabsorption period, to clarify the role of RFMS in regulating early body fluid balance in patients with large area burns, control of abnormal pulmonary water and prevention of pulmonary complications by PICCO monitoring. Early precision monitoring provides the basis for the prevention and treatment of pulmonary edema. The object and method adopted a non random prospective study method, through the examination and approval of the Southwest Hospital ethics review committee, the patients signed the informed consent. The control group collected 32 cases of large area burn patients admitted to the Department of burns in December, June 2012 -2014, and the restriction group collected 201 29 cases of large area burn patients in Southwest Hospital, Southwest Hospital in January -2016 years, 5 years. The two groups of shock period (2 days after injury) were treated in the same way. The control group was treated with the same routine treatment, the control group was treated with RFMS, that is, proper control of the total amount of rehydration and promoting the discharge of body fluid through diuresis (timing quantitative static push urine, 5mg/ times, 4-6 times, total 20-30mg/ days). The hemodynamic indexes of two groups of patients were continuously monitored by PICCO monitor (ELWI, pulmonary vascular permeability index PVPI, per stroke output index SVI, cardiac index CI, left ventricular contractile force index dpmx, mean arterial pressure MAP, total cardiac end diastolic volume index GEDI, thoracic cavity blood volume index ITBI, peripheral vascular resistance index SVRI). The nurses recorded the daily liquid entry and exit of two groups of patients and calculated the daily net balance of liquid and the daily accumulated liquid balance. Record the daily routine biochemical tests and the results of bacterial culture in two groups of patients. Records of the use of ventilator during the reabsorption period of the two groups, the incidence of ARDS, pulmonary infection and blood infection within 2 weeks after the injury, within 2 weeks. The occurrence of other visceral complications and the number of cases of disease worsening and death within 4 weeks after injury were analyzed by.SPSS22.0. The continuous data adopted mean standard deviation of mean number, independent sample t test, repeated measurement, and count data using chi 2 test and other statistical methods, and 1. demographic data of test level alpha =0.05. results were introduced. Two groups of patients were compared in age, sex, height, weight, time of admission, classification of causes of burn, inhalation injury and size of wound. There was no statistical difference (P0.05). There was a comparability of the effect of.2. reabsorption period RFMS on liquid balance in the reabsorption period of two groups. The difference between the sixth days was statistically significant (P0.05), and the daily accumulated liquid net balance of the two groups was higher than that of the control group, and the P value at each time point was less than 0.05, and the reabsorption limit group protein was slightly higher than the control group, and the serum potassium (K), and the blood sodium (Na) and other electrolyte concentrations were all in the group. After the effect of RFMS on hemodynamics in the normal level of.3. absorption period into the reabsorption period, the two groups of patients with GEDI and ITBI increased gradually, and at the peak of seventh Tianda after injury; after that, the GEDI and ITBI in the restricted group declined, to the lower limit of the normal range of tenth Tianda after injury, while the control group GEDI and ITBI were in a continuous high level after the injury on the 7-10 day after injury. The difference between two groups of GEDI was statistically significant at 4,10 days after injury. The difference between ITBI and tenth days after injury was statistically significant (P0.05). CI in two groups of patients in the reabsorption period were gradually higher than the normal upper limit, all at the peak of sixth in Tianda. The two groups of patients with MAP and SVI were in the normal range, and there was no statistical difference between the two. The myocardial contraction index of the restricted group was slightly higher than the control group on day 4-10 after injury, and the limit group SVRI was slightly higher than the control group at the end of the injury after the injury to the control group at the.4. reabsorption period of RFMS to the two groups of ELWI and OI in the reabsorption period of the control group, which were all higher than the normal values. The limit group was higher than the upper limit of normal value only 7-9 days after injury, and the control group in the reabsorption period was higher than the limit group, and the difference between the fourth days was statistically significant (P0.05). The total days of the abnormal ELWI in the two groups were 82 days in the restriction group and 134 days in the control group; the proportion of the abnormal days of the ELWI was 35.3% and 52.3% respectively, and the two comparison was compared. There was a statistical difference (P0.01). In the two groups, the OI showed a downward trend in the reabsorption period, and the decrease was more obvious in the control group. The 3-8 day after the injury in the control group was higher than that of the control group, the use of RFMS ventilator and the lung complications in the.5. reabsorption period of the control group were 15 cases in the control group and 6 in the restricted group, and the two of the two groups had a significant difference. P=0.030.05. The total days of the control group were 105 days, 41.02% of the total days in the reabsorption period, 3.28 days per person, 43 days for the total days of the ventilator in the restricted group, 18.53% of the total days in the reabsorption period, 1.48 days per person, and two (P=0.000.01). In the 2 weeks after injury, 4 cases were ARDS, 12 cases in the control group and 5 in the restriction group. There were 14 cases of pulmonary infection and 14 cases in the control group, and there were statistically significant differences (P0.05) in the.6. reabsorption period, the effect of RFMS on blood infection, other organ complications and death in 2 weeks after injury, the incidence of blood infection was 6 cases in the restricted group and 18 in the control group. The P value was less than 2 weeks after the 0.05. injury, and 6 other 4 species occurred in the restricted group. 15 cases of other 8 organ complications in the control group, the P value was less than 0.05, the difference was statistically significant. Within 4 weeks after the injury, 1 cases were dead, 9 cases were deteriorated, 7 cases in the control group died, 15 cases deteriorated, and the two were all less than 0.05 in the P value, and the difference had the significance of overall planning. Conclusion the RFMS in the 1. absorption period could effectively reduce the large area. The daily net balance of the liquid and the accumulated liquid balance can improve the plasma protein content to a certain extent. There is no obvious effect on the electrolyte concentration in the.2. absorption period. RFMS can effectively control the increase of large area burn capacity, improve the cardiac function to a certain extent, and have no adverse effect on the other hemodynamic indexes in the.3. recovery period, RFMS can be effectively prevented. The abnormal increase of ELWI in patients with large area burns, a certain degree of improvement of pulmonary oxygenation, reducing the use of ventilator, reducing pulmonary infection and ARDS and other lung complications in.4. recovery period RFMS can reduce the occurrence of other organ complications and blood flow infection in the early stage of large area burns, reduce the disease and reduce the mortality, and improve the prognosis of large area burns. It is of positive significance.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.6
本文編號(hào)：2124774
[Abstract]:Background and objective large area burns patients have many complications, and the incidence of lung complications is the highest. Pulmonary edema is easy to occur in the early stage of large area burns, pulmonary edema is pulmonary infection, acute respiratory distress syndrome (ARDS) or respiratory dysfunction can cause multiple organ function in patients with large area burns. Failure (MODS) or even death has an important influence on the prognosis and prognosis of patients with large area burns. The traditional pulmonary water monitoring method can not accurately measure the content of the extravascular lung water, and the operation is complex and the clinical practicability is not high. The monitoring and prevention of early pulmonary water in the patients with large area burns is limited. There is a positive correlation. The degree of pulmonary edema can be quantified by pulse indicator continuous cardiac output (PICCO) capacity monitor by the content of the extravascular lung water (indicator continuous cardiac output, PICCO). The quantitative monitoring of the content of extravascular pulmonary water in patients with the bed side of the bed is the only new technique for the quantitative monitoring of the content of the lung water by the dynamic side of the bed. With PICCO continuous monitoring, patients with large area burns entered the reabsorption period (3-10 days after injury), and the extravascular pulmonary edema index (ELWI) showed a continuous increase, which was higher than the normal high value (7mL/kg). It showed that there were different degrees of pulmonary edema in the early stage of large area burn. The early lung function of area burns was negatively correlated with ELWI. The above study revealed the early changes in the lung water and its possible clinical significance. The restrictive liquid management strategy (restrictive fluid management strategy, RFMS) means to keep the body fluid negative balance for a period of time and limit the amount of liquid input, A number of [2]. studies show that RFMS can obviously improve the lung function and prognosis of acute lung injury (ALI), infection, ARDS, shock, and [3][4][5], but there is no related research in the field of burn. Therefore, we speculate that RFMS can reduce the burden, reduce the content of lung water and improve the oxygenation function of the patients with large area burns at the reabsorption period. To reduce the lung complications and improve the prognosis. The purpose of this study is to use RFMS and conventional liquid management for patients with large area burns in the reabsorption period, to clarify the role of RFMS in regulating early body fluid balance in patients with large area burns, control of abnormal pulmonary water and prevention of pulmonary complications by PICCO monitoring. Early precision monitoring provides the basis for the prevention and treatment of pulmonary edema. The object and method adopted a non random prospective study method, through the examination and approval of the Southwest Hospital ethics review committee, the patients signed the informed consent. The control group collected 32 cases of large area burn patients admitted to the Department of burns in December, June 2012 -2014, and the restriction group collected 201 29 cases of large area burn patients in Southwest Hospital, Southwest Hospital in January -2016 years, 5 years. The two groups of shock period (2 days after injury) were treated in the same way. The control group was treated with the same routine treatment, the control group was treated with RFMS, that is, proper control of the total amount of rehydration and promoting the discharge of body fluid through diuresis (timing quantitative static push urine, 5mg/ times, 4-6 times, total 20-30mg/ days). The hemodynamic indexes of two groups of patients were continuously monitored by PICCO monitor (ELWI, pulmonary vascular permeability index PVPI, per stroke output index SVI, cardiac index CI, left ventricular contractile force index dpmx, mean arterial pressure MAP, total cardiac end diastolic volume index GEDI, thoracic cavity blood volume index ITBI, peripheral vascular resistance index SVRI). The nurses recorded the daily liquid entry and exit of two groups of patients and calculated the daily net balance of liquid and the daily accumulated liquid balance. Record the daily routine biochemical tests and the results of bacterial culture in two groups of patients. Records of the use of ventilator during the reabsorption period of the two groups, the incidence of ARDS, pulmonary infection and blood infection within 2 weeks after the injury, within 2 weeks. The occurrence of other visceral complications and the number of cases of disease worsening and death within 4 weeks after injury were analyzed by.SPSS22.0. The continuous data adopted mean standard deviation of mean number, independent sample t test, repeated measurement, and count data using chi 2 test and other statistical methods, and 1. demographic data of test level alpha =0.05. results were introduced. Two groups of patients were compared in age, sex, height, weight, time of admission, classification of causes of burn, inhalation injury and size of wound. There was no statistical difference (P0.05). There was a comparability of the effect of.2. reabsorption period RFMS on liquid balance in the reabsorption period of two groups. The difference between the sixth days was statistically significant (P0.05), and the daily accumulated liquid net balance of the two groups was higher than that of the control group, and the P value at each time point was less than 0.05, and the reabsorption limit group protein was slightly higher than the control group, and the serum potassium (K), and the blood sodium (Na) and other electrolyte concentrations were all in the group. After the effect of RFMS on hemodynamics in the normal level of.3. absorption period into the reabsorption period, the two groups of patients with GEDI and ITBI increased gradually, and at the peak of seventh Tianda after injury; after that, the GEDI and ITBI in the restricted group declined, to the lower limit of the normal range of tenth Tianda after injury, while the control group GEDI and ITBI were in a continuous high level after the injury on the 7-10 day after injury. The difference between two groups of GEDI was statistically significant at 4,10 days after injury. The difference between ITBI and tenth days after injury was statistically significant (P0.05). CI in two groups of patients in the reabsorption period were gradually higher than the normal upper limit, all at the peak of sixth in Tianda. The two groups of patients with MAP and SVI were in the normal range, and there was no statistical difference between the two. The myocardial contraction index of the restricted group was slightly higher than the control group on day 4-10 after injury, and the limit group SVRI was slightly higher than the control group at the end of the injury after the injury to the control group at the.4. reabsorption period of RFMS to the two groups of ELWI and OI in the reabsorption period of the control group, which were all higher than the normal values. The limit group was higher than the upper limit of normal value only 7-9 days after injury, and the control group in the reabsorption period was higher than the limit group, and the difference between the fourth days was statistically significant (P0.05). The total days of the abnormal ELWI in the two groups were 82 days in the restriction group and 134 days in the control group; the proportion of the abnormal days of the ELWI was 35.3% and 52.3% respectively, and the two comparison was compared. There was a statistical difference (P0.01). In the two groups, the OI showed a downward trend in the reabsorption period, and the decrease was more obvious in the control group. The 3-8 day after the injury in the control group was higher than that of the control group, the use of RFMS ventilator and the lung complications in the.5. reabsorption period of the control group were 15 cases in the control group and 6 in the restricted group, and the two of the two groups had a significant difference. P=0.030.05. The total days of the control group were 105 days, 41.02% of the total days in the reabsorption period, 3.28 days per person, 43 days for the total days of the ventilator in the restricted group, 18.53% of the total days in the reabsorption period, 1.48 days per person, and two (P=0.000.01). In the 2 weeks after injury, 4 cases were ARDS, 12 cases in the control group and 5 in the restriction group. There were 14 cases of pulmonary infection and 14 cases in the control group, and there were statistically significant differences (P0.05) in the.6. reabsorption period, the effect of RFMS on blood infection, other organ complications and death in 2 weeks after injury, the incidence of blood infection was 6 cases in the restricted group and 18 in the control group. The P value was less than 2 weeks after the 0.05. injury, and 6 other 4 species occurred in the restricted group. 15 cases of other 8 organ complications in the control group, the P value was less than 0.05, the difference was statistically significant. Within 4 weeks after the injury, 1 cases were dead, 9 cases were deteriorated, 7 cases in the control group died, 15 cases deteriorated, and the two were all less than 0.05 in the P value, and the difference had the significance of overall planning. Conclusion the RFMS in the 1. absorption period could effectively reduce the large area. The daily net balance of the liquid and the accumulated liquid balance can improve the plasma protein content to a certain extent. There is no obvious effect on the electrolyte concentration in the.2. absorption period. RFMS can effectively control the increase of large area burn capacity, improve the cardiac function to a certain extent, and have no adverse effect on the other hemodynamic indexes in the.3. recovery period, RFMS can be effectively prevented. The abnormal increase of ELWI in patients with large area burns, a certain degree of improvement of pulmonary oxygenation, reducing the use of ventilator, reducing pulmonary infection and ARDS and other lung complications in.4. recovery period RFMS can reduce the occurrence of other organ complications and blood flow infection in the early stage of large area burns, reduce the disease and reduce the mortality, and improve the prognosis of large area burns. It is of positive significance.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.6
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