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題 名 | Goal-Directed Fluid Resuscitation Protocol Based on Arterial Waveform Analysis in Major Burns: The First 48 Post Burn Hours=針對大燒傷病患傷後48小時內以動脈波形分析為目標導向之液體復甦指南 |
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作 者 | 喬浩禹; 王志信; 曾元生; 陳錫根; 陳天牧; 戴念梓; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷 期 | 26:1 2017.03[民106.03] |
頁 次 | 頁45-52 |
分類號 | 416.141 |
關鍵詞 | 液體復甦; 動脈波形分析; 心搏量變異率; 大燒傷; 目標導向治療; Fluid resuscitation; Arterial waveform analysis; Stroke volume variation; Major burn; Goal-directed therapy; |
語 文 | 英文(English) |
中文摘要 | 背景:在早期燒傷治療時期,有效的輸液復甦是十分重要的。過多輸液通常導因於不正確地計算輸液需求,許多研究評估心搏量變異率對於預測體液變化反應有其可靠性。最近許多證據表示,目標導向治療對於病患預後有明顯益處。目的及目標:此篇研究旨在評估使用標準尿排出量合併以動脈波形分析FloTrac^(TM) 系統之目標導向輸液復甦指南,針對大燒傷病患來調整輸液治療及避免過多輸液之效益。材料及方法:我們針對台灣新北市八仙樂園彩虹粉塵爆炸,進行一個18位大燒傷病患於三軍總醫院之回溯性群體研究。8位病患於進階血液動力學監測儀器組(FloTrac^(TM)系統,目標導向治療組),10位病患於標準監測組(標準組)。輸液治療之調整以達到每小時尿排出量30至50毫升,心輸出指數大於2.5L/minute/m^2,及心搏量變異率小於12%。我們根據每小時心搏量變異率及尿排出量來調整每小時晶體溶液輸入量。結果:於目標導向治療組,平均燒傷全身體表面積為66% ± 14%;於標準治療組,平均燒傷全身體表面積為60% ± 11% (P = 0.301)。所有病人都有吸入性燒傷。第一個24小時液體輸入量 (ml/kg/%TBSA),目標導向治療組比起標準治療組顯著減少3.22 ± 1.04 對比5.11 ± 0.63 (P = <0.001);第二個24小時液體輸入量 (ml/kg/%TBSA),目標導向治療組比起標準治療組顯著減少2.63 ± 0.61 versus 4.05 ± 0.66 (P = <0.001)。第一及第二個24小時尿排出量(ml/kg/hr)兩組沒有差異,併發症發生率兩組沒有差異,所有大燒傷病患無人死亡。結論:於早期燒傷輸液時期,體液多寡也許不能從標準每小時尿量反應。以心搏量變異率為基礎之目標導向輸液復甦治療指南,顯示出安全且避免過多輸液。我們仍然需要後續前瞻性研究來證明,以心搏量變異率為基礎之目標導向復甦治療會改變大燒傷病患預後。 |
英文摘要 | Background: Effective fluid resuscitation during early postburn period is vital. Fluid creep usually results from inaccuracies in calculating fluid requirement. Many studies had assessed the reliability of stroke volume variation (SVV) in predicting fluid responsiveness. Goal-directed therapies (GDT) showed good benefits to patients in recent evidence. Aim and Objectives: This study aimed to evaluate the value of a goal-directed fluid resuscitation protocol that used standard measure of urine output plus arterial waveform analysis FloTrac^(TM) system for major burns to adjust fluid therapy and avoid fluid creep. Materials and Methods: We conducted a retrospective cohort study of 18 major burn patients at Tri-service General Hospital after Formosa Fun Coast Dust Explosion Disaster in New Taipei, Taiwan. 8 patients were allocated into the enhanced hemodynamic monitoring group (FloTrac^(TM) system, GDT-group). 10 patients were allocated into a standard management group (Standard -group). Fluid therapy was adjusted to achieve urine output (30~50ml/hour), CI > 2.5 L/minute/m^2 and SVV < 12%. We titrated the hourly crystalloid fluid input based on SVV and hourly urine output. Results: In GDT-group, the mean total body surface area (TBSA) burned was 66% ± 14%. In Standard-group, mean TBSA was 60% ± 11% (P = 0.301). All patients sustained inhalation injury. The first 24 hours fluid input (ml/kg/%TBSA) was significantly reduced in the GDT-group with 3.22 ± 1.04 versus 5.11 ± 0.63 (P = <0.001). The second 24 hours fluid input (ml/kg/%TBSA) was significantly reduced in the GDT-group with 2.63 ± 0.61 versus 4.05 ± 0.66 (P = <0.001). The first and second 24 hours urine output (ml/kg/hr) revealed no differences between groups. Complication showed no differences between groups. No mortality was found in all major burn patients. Conclusion: Fluid responsiveness during the early burn resuscitation phase might not be reflected by standard hourly urine output. SVV-based goal-directed fluid resuscitation protocol seems to be safe and avoids unnecessary fluid input. We still need further prospective study to prove that SVV-based GDT will alter the outcomes of major burn patients. |
本系統中英文摘要資訊取自各篇刊載內容。