發(fā)布時(shí)間：2018-07-31 10:40

【摘要】：目的通過總結(jié)分析近年來我院大面積燒傷病動(dòng)脈血?dú)饧八釅A平衡變化情況,探討PH值、SB、PaCO2、堿剩余、乳酸、PaO2等內(nèi)環(huán)境監(jiān)測指標(biāo)在燒傷治療中的價(jià)值及具體數(shù)值范圍,以及對(duì)燒傷患者病情變化和預(yù)后的影響。為臨床工作提供參考借鑒。資料與方法按一定的納入和排除標(biāo)準(zhǔn),收集自2010年12月至2014年09月廣西醫(yī)科大學(xué)一附院燒傷科收治的59例大面積燒傷患者的病歷資料。分為死亡組和存活組,對(duì)兩組患者的動(dòng)脈血PH值、SB、PaCO2、堿剩余、乳酸、PaO2進(jìn)行統(tǒng)計(jì)分析。對(duì)數(shù)據(jù)行t檢驗(yàn)或x2檢驗(yàn)。結(jié)果1、大面積燒傷患者,傷后8h段動(dòng)脈血PH值死亡組為(7.24±0.08),存活組為(7.31±0.09);傷后24h段死亡組PH值為(7.28±0.11),存活組為(7.35±0.08);傷后48h段死亡組PH值為(7.36±0.13),存活組為(7.41±0.04)。兩組各時(shí)段PH值有明顯差異(P0.05)。傷后48h段PH值正�；颊咚劳雎蕿�10.0%,PH值大于7.45的患者死亡率為40.0%,兩組患者的死亡率差異有統(tǒng)計(jì)學(xué)意義。2、傷后8h段死亡組動(dòng)脈血SB為(16.5±2.8)mmol/L,存活組為(18.6±3.8)mmol/L;傷后24h段死亡組SB均值為(17.4±4.1)mmol/L,存活組為(20.4±3.6)mmol/L;兩組SB值有明顯差異(P0.05)。傷后48h段死亡組SB為(21.7±6.1)mmol/L,存活組為(23.3±2.7)mmol/L。兩組差異不顯著(P0.05)。傷后48h段SB大于27mmol/L患者死亡率為50.0%,SB正�；颊咚劳雎蕿�11.8%,兩組患者的死亡率差異顯著(P0.05)。3、傷后8h段paco235mmhg的患者與paco2正常的患者死亡率差異無統(tǒng)計(jì)學(xué)意義。余各時(shí)間段,paco235mmhg、paco245mmhg的患者與paco2正常的患者死亡率差異均有統(tǒng)計(jì)學(xué)意義。4、傷后8h段死亡組動(dòng)脈血be為(-10.5±4.4)mmol/l,存活組為(-7.5±4.3)mmol/l;傷后24h段死亡組be為(-8.5±4.6)mmol/l,存活組恢復(fù)至(-4.9±3.8)mmol/l;傷后48h段死亡組be均值恢復(fù)至(-3.5±5.7)mmol/l,存活組恢復(fù)至(-1.0±2.8)mmol/l。兩組各時(shí)間段be值均有明顯差異(p0.05)。5、傷后8h段死亡組動(dòng)脈血乳酸為(5.3±2.3)mmol/l,存活組為(4.3±1.9)mmol/l;傷后24h段死亡組乳酸為(4.5±2.9)mmol/l,存活組為(3.3±1.8)mmol/l;傷后48h段死亡組乳酸為(3.5±1.4)mmol/l,存活組為(2.5±1.3)mmol/l。兩組傷后各時(shí)段乳酸含量差異明顯(p0.05)。6、傷后24小時(shí)段及48小時(shí)段pao280mmhg的患者與pao2正常的患者死亡率差異有統(tǒng)計(jì)學(xué)意義。余各時(shí)段pao2正常的患者與pao280mmhg的患者、pao2100mmhg的患者死亡率差異無統(tǒng)計(jì)學(xué)意義。結(jié)論1、大面積燒傷患者,傷后8小時(shí)ph值小于7.3預(yù)示病情嚴(yán)重,死亡率較高。傷后24小時(shí)內(nèi)的治療情況對(duì)預(yù)后有明顯影響。至48小時(shí)ph值偏堿的患者增多,且有較高的死亡率,臨床上要引起重視。2、大面積燒傷病傷后8小時(shí)sb值在18.5mmol/l以上,傷后24小時(shí)sb值達(dá)到20mmol/l以上者死亡率較低;傷后48小時(shí)sb大于27mmol/l的患者死亡率亦高,臨床上要引起重視。3、大面積燒傷病對(duì)預(yù)后有重要影響,臨床上要積極處理。24小時(shí)后要及時(shí)有效改善呼吸性堿中毒。4、大面積燒傷患者動(dòng)脈血be含量與死亡率相賈。傷后8小時(shí)be在-7.5mmol/l以上;傷后24小時(shí)在-5mmol/l以上能改善預(yù)后。5、大面積燒傷患者動(dòng)脈血乳酸含量與死亡率相賈。通過救治傷后24小時(shí)乳酸控制在3.5mmol/l以下,能有效降低死亡率。
[Abstract]:Objective by summarizing and analyzing the changes of arterial blood gas and acid-base balance of large area burns in our hospital in recent years, the value and the specific value range of the environmental monitoring indexes of pH, SB, PaCO2, alkali residue, lactic acid and PaO2 in the treatment of burn were discussed, and the effects on the change and prognosis of the burn patients were also discussed. Materials and methods according to certain inclusion and exclusion criteria, 59 cases of large area burn patients admitted from December 2010 to 09 months of 2014 were collected from the Department of burn of Guangxi Medical University. The data were divided into the death group and the survival group. The arterial blood pH value, SB, PaCO2, alkali residue, lactic acid and PaO2 were statistically analyzed in two groups of patients. The data were examined by t. Results or x2 test. Results 1, patients with large area burns were (7.24 + 0.08) and (7.31 + 0.09) in the survival group (7.28 + 0.11) in the survival group and (7.35 + 0.08) in the 24h segment after injury, and (7.36 + 0.13) in the 48h segment after injury (7.36 + 0.13) and (7.41 + 0.04) in the survival group (7.41 + 0.04). There were significant differences in pH value in each period of each group (P0.05). The mortality of normal patients in 48h segment after injury was 10%, the mortality of patients with pH value greater than 7.45 was 40%, the mortality difference in two groups was statistically significant.2, the SB of arterial blood in 8h segment after injury was (16.5 + 2.8) mmol/L, and the survival group was (18.6 + 3.8) mmol/L; the SB mean of 24h segment after injury was (17.4 + 4.1) mmol/L, and the survival group was (20.4 + 3.6) mmol. The SB values in the two groups were significantly different (P0.05). The SB in the 48h segment after injury was (21.7 + 6.1) mmol/L, and the survival group was (23.3 + 2.7) mmol/L. two (P0.05). The mortality rate of 48h segment SB greater than 27mmol/L was 50%, the mortality rate of the normal SB patients was 11.8%, and the mortality difference in the two group was significant. There was no significant difference in the mortality between the PaCO2 and the normal patients. The mortality of paco235mmhg, paco245mmhg and PaCO2 was statistically significant.4. The arterial blood be in the 8h segment after injury was (-10.5 + 4.4) mmol/l and the survival group was (-7.5 + 4.3) mmol/l. The survival group recovered to (-4.9 + 3.8) mmol/l, and the mean be in the 48h segment after injury was recovered to (-3.5 5.7) mmol/l, the survival group recovered to (-1.0 + 2.8) mmol/l. two, and the be values in each time period were significantly different (P0.05).5. The arterial blood lactic acid was (5.3 + 2.3), and the survival group was 4.3 + 1.9, and the lactic acid in the dead group after injury was (4.5 +). 2.9) mmol/l, the survival group was (3.3 + 1.8) mmol/l, and the lactate in the 48h segment after injury was (3.5 + 1.4) mmol/l, the survival group was (2.5 + 1.3) mmol/l. two after the injury (P0.05).6. The mortality difference between the patients with pao280mmhg in 24 hours and 48 small periods after injury and in the normal PaO2 patients was statistically significant. The remaining PaO2 was normal. There was no significant difference in mortality between patients with pao280mmhg and patients with pao2100mmhg. Conclusion 1, 8 hours after injury, the pH value of less than 7.3 indicates a serious condition and a higher mortality rate. The treatment in 24 hours after injury has a significant impact on the prognosis. To 48 hours, the patients with pH value are increased and have a higher mortality rate. In clinical, we should pay attention to.2. The sb value of 8 hours after large area burns is above 18.5mmol/l, and the death rate of those who have reached 20mmol/l above 20mmol/l 24 hours after injury is low; the mortality of patients with sb greater than 27mmol/l after 48 hours after injury is also high. It is important to pay attention to.3 in clinic, and large area burns have an important influence on the prognosis, and we should actively deal with.24 hours in clinical. It is necessary to improve the.4 of respiratory alkalosis in time and effectively. The arterial blood be content and the mortality rate of the patients with large area burns are more than -7.5mmol/l 8 hours after injury. The prognosis is better than -5mmol/l after 24 hours after injury. The content of lactic acid in the arterial blood and the death rate of the large area burn patients are in accordance with the death rate. 24 hours after the injury, the lactic acid is controlled in 3.5mmol/l. The following can effectively reduce the mortality rate.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R644

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李云霞,楊麗,王淑萍;大面積燒傷并發(fā)ARDS護(hù)理[J];武警醫(yī)學(xué)院學(xué)報(bào);2001年02期

2 劉洪琪 ,邢玉璽,邢同義,李德水,郭振存;“五及時(shí)”治療措施在大面積燒傷中的應(yīng)用[J];武警醫(yī)學(xué)院學(xué)報(bào);2001年04期

3 鮑金明;56例大面積燒傷救治體會(huì)[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2001年11期

4 沈光裕,段紅杰,周金武;熱帶海島戰(zhàn)區(qū)不同時(shí)期救治大面積燒傷診治經(jīng)驗(yàn)[J];中華外科雜志;2002年03期

5 蘇海濤,李宜姝,黃麗濱,李宗瑜,張秀英;32例小兒大面積燒傷救治體會(huì)[J];中國急救醫(yī)學(xué);2002年05期

6 曾展倫,許懷達(dá);256例小兒大面積燒傷治療分析[J];華夏醫(yī)學(xué);2002年03期

7 趙永健,劉群,鄧詩琳;大面積燒傷病人血液高凝狀態(tài)分析[J];河北醫(yī)藥;2002年06期

8 周蓉,林靜,王茵;大面積燒傷患者康復(fù)期護(hù)理[J];實(shí)用醫(yī)藥雜志;2002年08期

9 雷晉,蘧勤勤,趙志偉,郝振明,段鵬,成劍;運(yùn)用“四早”方案救治大面積燒傷[J];山西醫(yī)科大學(xué)學(xué)報(bào);2002年02期

10 沈光裕;大面積燒傷早期功能康復(fù)[J];傷殘醫(yī)學(xué)雜志;2002年03期

相關(guān)會(huì)議論文 前10條

1 馮艷;高彩宏;羅金芳;李文麗;;大面積燒傷后的功能康復(fù)[A];第六屆全國燒傷救治專題研討會(huì)論文匯編[C];2009年

2 嚴(yán)敏岳;;大面積燒傷患者康復(fù)期的危險(xiǎn)因素與護(hù)理對(duì)策[A];浙江省醫(yī)學(xué)會(huì)燒傷外科學(xué)術(shù)年會(huì)論文匯編[C];2009年

3 馮艷;高彩宏;羅金芳;李文麗;;大面積燒傷后的功能康復(fù)[A];中華醫(yī)學(xué)會(huì)燒傷外科學(xué)分會(huì)2009年學(xué)術(shù)年會(huì)論文匯編[C];2009年

4 祁麗;張韶欣;杜慧青;左冬梅;祁亮亮;侯雪;李素玲;;小兒大面積燒傷的護(hù)理體會(huì)[A];第七屆中國醫(yī)師協(xié)會(huì)美容與整形醫(yī)師大會(huì)論文集[C];2010年

5 方意娟;;大面積燒傷后期患者功能康復(fù)相關(guān)因素的調(diào)查分析[A];第七屆中國醫(yī)師協(xié)會(huì)美容與整形醫(yī)師大會(huì)論文集[C];2010年

6 劉曉芹;李濟(jì)時(shí);;181例大面積燒傷患者心電圖回顧分析[A];全國第三屆燒傷外科學(xué)術(shù)交流會(huì)議論文摘要[C];1991年

7 李自文;李宏;;邊遠(yuǎn)基層醫(yī)院成批大面積燒傷病人的綜合治療[A];中華醫(yī)學(xué)會(huì)第五次全國燒傷外科學(xué)術(shù)會(huì)議論文匯編[C];1997年

8 何國;;大面積燒傷101例的治療總結(jié)[A];中華醫(yī)學(xué)會(huì)第五次全國燒傷外科學(xué)術(shù)會(huì)議論文匯編[C];1997年

9 唐雨發(fā);;大面積燒傷38例救治體會(huì)[A];中華醫(yī)學(xué)會(huì)第六屆全國燒傷外科學(xué)術(shù)會(huì)議論文匯編[C];2001年

10 潘友華;;護(hù)理程序在大面積燒傷病人護(hù)理中的應(yīng)用[A];中華醫(yī)學(xué)會(huì)第六屆全國燒傷外科學(xué)術(shù)會(huì)議論文匯編[C];2001年

相關(guān)重要報(bào)紙文章 前10條

1 廣東省廣州市第二人民醫(yī)院 肖新民;治療大面積燒傷的臨床體會(huì)[N];健康報(bào);2013年

2 江蘇省射陽海河中心衛(wèi)生院 許興南;基層醫(yī)院救治大面積燒傷的臨床體會(huì)[N];健康報(bào);2007年

3 黃金華;大面積燒傷休克期心功能變化監(jiān)測的研究[N];農(nóng)村醫(yī)藥報(bào)（漢）;2007年

4 山東省兗礦集團(tuán)第二醫(yī)院燒傷整形科 王成傳;治療大面積燒傷創(chuàng)面的臨床體會(huì)[N];健康報(bào);2012年

5 北京美寶燒傷創(chuàng)瘍研究所 王洪生;應(yīng)用皮膚再生醫(yī)療技術(shù)救治特大面積燒傷的體會(huì)[N];健康報(bào);2007年

6 陜西省咸陽市禮泉縣燒燙傷皮膚病治療中心 蘇永鋒;應(yīng)用濕潤燒傷膏治療大面積燒傷的臨床效果觀察[N];健康報(bào);2008年

7 本報(bào)記者 胡海娟;從挽救生命到恢復(fù)美觀[N];開封日?qǐng)?bào);2009年

8 本報(bào)記者 陳宗立 本報(bào)通訊員 周文馨;將軍的氣魄 繡花的技巧[N];光明日?qǐng)?bào);2000年

9 記者 魏娜邋通訊員 周漢橋;我國首例異地皮膚捐贈(zèng)[N];長江日?qǐng)?bào);2008年

10 本報(bào)記者 蔡虹;“人造汗腺”解決燒傷者排汗困擾[N];北京科技報(bào);2010年

相關(guān)碩士學(xué)位論文 前8條

1 沈拓;多中心嚴(yán)重大面積燒傷患者長期健康相關(guān)生活質(zhì)量的調(diào)查與評(píng)價(jià)[D];第二軍醫(yī)大學(xué);2014年

2 葉秋楠;大面積燒傷死亡病例分析[D];吉林大學(xué);2013年

3 李輝煌;大面積燒傷病人早期動(dòng)脈血?dú)鈾z查相關(guān)指標(biāo)臨床分析[D];廣西醫(yī)科大學(xué);2015年

4 岳曉潔;我科近年來在大面積燒傷患者抗休克治療的回顧性研究[D];浙江大學(xué);2009年

5 紀(jì)雪亮;大面積燒傷患者合并糖尿病與并發(fā)應(yīng)激性高血糖的診治探討[D];廣西醫(yī)科大學(xué);2010年

6 盧鴻瑞;大面積燒傷病人氣管切開后并發(fā)氣管食管瘺一例[D];浙江大學(xué);2011年

7 李挺;應(yīng)用流體懸浮床治療大面積燒傷的報(bào)告[D];廣西醫(yī)科大學(xué);2006年

8 段晨旺;大面積燒傷超早期切痂的動(dòng)物實(shí)驗(yàn)研究[D];河北醫(yī)科大學(xué);2003年

，

本文編號(hào)：2155334