目的 探讨烧伤休克延迟快速复苏治疗方案。方法伤后4- 8h后入院的大面积烧伤病人20例，分为血浆复苏组和4%琥珀酰明胶复苏组，在血流动力学监护下快速补液。监测血流动力学、血液流变学、组织氧合指标和主要脏器功能及损伤指标。结果快速补液后2h内输入量加院外补液量占第1个24h公式计算量的百分比为48.34%，第1个24h实际输入量较公式计算量多31.42%；快速补液后，各观测指标均获改善。结论根据本研究结果，提出延迟快速复苏补液公式和方法如下：（1）第一个24h预计补液量（ml）= TBSA（%）×体重（kg）×2.6+水分2000mL，胶体与电解质之比为I：I。在血流动力学严密监护下，复苏的前2h将第一个24h液体总量的1/2快速补入；（2）第二个24h预计补液量（m1）=TBSA（%）×体重（k）×1+水分2000mL，胶体与电解质之比为1：1。

Cardiac dysfunction development in the early stage postburn has been an important problem in burn treatment. However, no eective therapies are available for use in clinical practice. In this study, we sought to determine whether early total eschar excision (EEE) in one operation and the traditional Chinese herb Panax notoginseng (PNS) would be helpful in improving early postburn cardiac function. 160 Wistar rats were randomly divided into burn (burn group, n=50), burn treated with EEE (EEE group, n=50), burn treated with PNS (PNS group, n=50) groups and normal controls (n=10). All rats except the normal control were given a 30% TBSA full skin thickness burn and resuscitated with Ringer’s lactate. EEE was performed immediately after the burn group received the first intraperitoneal injection of Ringer’s lactate. The wound was covered with homoskin from normal rats. In the PNS group, two doses of PNS (200 mg/kg for each dose) were given intraperitoneally immediately and 4 h postburn. Cardiac contractile function and cardiac troponin T (TnT) were determined at 1, 3, 6, 12 and 24 h postburn. Results showed that cardiac contractile parameters including AOSP, AODP, LVSP and +dp/dtmax all declined and were still significantly lower than the control values at 24 h postburn. Cardiac TnT was elevated markedly and reached a level 25 times higher than control at 12 h postburn. In EEE and PNS groups, the reduction of cardiac contractile function was limited as compared with that in the burn group. Levels of TnT in both EEE and PNS groups were significantly lower than in the burn group 6 h postburn later. The findings of this study demonstrated that both EEE and PNS were eective in improving early postburn cardiac function. # 1999 Elsevier Science Ltd and ISBI. All rights reserved.

为探讨吸入性损伤后多器官衰竭的临床特点及其防冶，对1977年1目至1991年8日4 834例住院病人中366例吸入性损伤进行了，回顾性分析。结果显示4834倒烧伤病人中发生MOF 115例，发生率为2.38%，其中366例吸入伤76例发生MOF，发生率达20.77%，占烧伤后MOF总数的2/3。吸入伤后MOF具有发生早、发生率和死亡率较高，呼吸系统并发症多，肺和心功能衰竭发生率高，重度休克较多，缺氧及酸中毒较严重等特点。认为吸入伤本身和休克是吸入伤后MOF的主要发病因素，受早采取有效措施防治吸入伤和休克，减轻或纠正组织器官的缺血和缺氧损害，是防治吸入伤后MOF的关键。

目的：探索大面积II度烧伤一次性切痂手术的可行性，方法：10例烧伤病人（总面积35%～85%，II度20%～60%），手术前Swan-Cans导管于流血动力，血气等动态监测下，一次将II度烧伤创面全部切除，用异体和（或）自体皮全覆盖，结果，最大切痂面积为60%，最大手术面积（切痂及供皮）达71%，术中血流动力及组织氧合指标短时间降低，术后均迅速回他升，24h多可恢复，术后均未发生内脏并发症，10例均治愈，平均住院时间为45.9d，结论：在严重监护下行大面积II度烧伤一次切痂不仅可行，且能缩短疗程，减少并发症，提高治愈率，但应掌握一定适应证。