Clinical Study On Relationship Between Fluid Administration During Shock Period And28-day-survival Condition And Complication Following Severe Burn In100Adult Patients

Objective:To review100adult severe burn patients’hospital clinical records in the Burn Research Institute of Yunnan Province in2012January to2013July. Analysis the status, characteristics and problems of severe burn fluid therapy during shock period. To investigate the factors influencing occurrence of severe burn patients prognosis and complications in28days. Provide certain reference for raising the level of diagnosis and treatment in the future.Method:Screening100hospital clinical records of patients with severe burn from2012January to2013July in our burn institute. Statistics the amount of fluid resuscitation in the48hours after burn. To compare the difference between actual amount of liquid recovery and the expected volume of national formula of resuscitation (NFR). Taking the patients’basic situation, burn characteristics, shock period resuscitation situation as variables, the28-day-survival condition and complications as the dependent variable.Using logistic regression to analise the relationship between complication and variables. Using Cox regression to analise the relationship between28-day-survival condition and variable.Results:1.Comparise the volume dfference between actual infusion and prediction of the NFR. The T test result of the first8hours fluid infusion volume is t=13.58, p=0.00<0.05.This means there is statistical difference.The first8hours actual fluid infusion volume is less than the predicted amount of42.5%(1.83±1.35L).The less fluid infusion may result in Hypovolemic shock. The rank test result of the second24hours fluid infusion volume is Z=6.736, p=0.00<0.05,this means there is statistical difference. The second24hours actual fluid infusion volume is much than the predicted amount of43.5%(1.91±2.49L). In the follow-up analysis of this study,we find the deviation of fluid infusion volume has certain effects on the complications and28day survival condition.The rank test result of the first24hours fluid infusion volume is Z=0.088, p=0.930>0.05.This means there is no statistical difference in the first24hours fluid infusion volume.2Through Logistic regression analysis of the complication and Cox regression analysis of the28day survival condition, we get the following regression equation and the OR or RR value.Bacteremialogit (p)=-3.422+2.184Incision of trachea+0.001The crystalvolumeof the first8hours, Incision of tracheaOR=8.883, The crystal volumeof he first8hours OR=1.001. PneumoniaLogti (p)=-3.170+1.142Incision of trachea+0.001The colloid volume of second24hours, Incision of tracheaOR=3.134,The colloid volume of second24hours OR=1.001. ARDSlogit (p)=-4.858+1.591Incision of trachea+0.001The colloid volume of second24hours, Incision of tracheaOR=4.91, The colloid volume of second24hours OR=1.001. MODS logit (p)=-4.858+2.238Incision of trachea+0.001The colloid volume of second24hours,Incision of tracheaOR=9.378, The colloid volume of second24hours OR=1.001.28-day-survival conditionIn[h(t)/h0(t)]=1.686Incision of trachea+1.532Hypovolemic shock+0.001The water component of second24hours+2.829Pneumonia+1.045ARDS Inhalation injuryRR=5.296, Hypovolemic shockRR=4.625, water component of second24hours RR=1.001, Pneumonia RR=16.924, ARDS RR=2.844.1.Conclusion:1Beacause of the unconvenient traffic and been shorted of the professional burn department in Basic Hospital, the early fluid resuscitation treatment is not sufficient, leads to the statistical results is that the fluidresuscitation of the first8h after burn is less than the amount expected volume formula. The burn center take activeand effective treatment of fluid resuscitation, the most severe burn patients were stable during the shock stage.The mortality of shock stage is low (7%).2On clinical the face and neck burns and inhalation injury patients need preventive tracheotomy, prevention of asphyxia. And the atomization, turn over, sputum aspiration and sterile operation nursing should been strengthen. Early extubation, should stay offline and improved pulmonary function, reduce therisk of infection and complications.3Regression analysis of bacteremia, except the trachea cut away,"the first8h crystal defects" are related risk factors (OR=1.001), it was suggested that the fluid resuscitation of burn early and timely, fast, fully, reduce the occurrence of bacteremia.4Spread fire emergency knowledge, reduce the incidence and severity of inhalation injury. Prevention of pneumonia, sequential interrupt ARDS to MODS process. Through the active prevention and treatment of complications, improve patient survival at28days.5Burn center survival after17days of survival curves of severe burn patients rehydration rate began to decrease obviously, only to provide some reference for clinical judgment of prognosis.