Retrospective Analysis Of Delayed Resuscitation In Children With Severe Burn Shock

Objectives Burns are one of the most common causes of death and accidental injuries in children.Because of the special physiological characteristics of children,burns in children are often more severe than in adults.For children with severe burn shock and delayed resuscitation,timely,effective and correct fluid resuscitation treatment during the shock period can effectively reduce burn complications and mortality,and has a positive role in improving and improving the treatment level of children with severe burns.Proper fluid resuscitation and optimal fluid management are major determinants of survival in patients with severe burns.How to ensure adequate perfusion of tissues after burns and perform reasonable fluid resuscitation at the same time,so that patients can survive the shock period smoothly,reduce the incidence of complications and mortality in the subsequent course of disease,and become the hotspot of resuscitation during burn shock.Methods A retrospective analysis of clinical data of 55 children with burn shock and delayed resuscitation admitted to the First Affiliated Hospital of Anhui Medical University from April 2012 to April 2017.All patients were treated with liquid resuscitation after admission.General information(sex,age,Admission time after injury,TBSA,? ° burn area,cause of burns,etc.),vital signs(heart rate,respiration,blood pressure,urine output,etc.),fluid resuscitation during shock((1)first 8h,first 24 h,second 24 h Total fluid rehydration and average urine volume(8h,24 h,48h,72h);(2)grouping according to different delayed resuscitation time,age,and burn area in children,the first 24 h of the amount of crystals,colloids,sugar and water The amount of fluid is recorded in detail,and the rehydration volume and efficacy of different groups are compared and analyzed.),Test results((1)routine blood tests: hematocrit,hemoglobin,white blood cells,etc.;(2)liver function tests: albumin,ALT,AST,etc.(3)Renal function tests: creatinine,urea,etc.;(4)Electrolyte tests: sodium,potassium,and chlorine.(Check each time before and after rehydration)for statistical analysis.Result General information:(1)This study met the inclusion criteria for a total of 55 cases,of which 32 were male(58.2%)and 23 were female(41.8%);2 were discharged automatically without death.(2)Age distribution: The age ranged from 6 months to 6 years,with an average of 2.5 years ± 1.7 years;(3)The hospital admission time after injury was 3h to 8.5h;(4)The total area of burns and deep burns was 20% to 75% TBSA,with an average of 35.4 % ± 12.5% TBSA,of which 29 cases had ? ° burn,and the area was 1%~18% TBSA,with an average of 5.53% ± 5.01% TBSA.Rehydration: 26 cases of pediatric shock were improved within 8 hours of intravenous fluid rehydration,29 cases were improved after 8 hours,and urine volume was maintained to be satisfactory in 51 cases(blood pressure,breathing,pulse,etc.remained normal).The average urine volume before and after intravenous infusion was different.There was statistical significance(all P <0.05).(2)The total amount of fluid replacement within 8 hours before rehydration was(1014±378)ml,accounting for 94.8%±37.1% of the calculated amount in the first 24 h formula.The actual total fluid replacement in the first 24 h was(2377±578)ml,accounting for the first 1 112.6%±34.8% of the calculated amount of the 24 h rehydration formula;the actual rehydration amount of the second 24 h was(1642±365)ml,accounting for 78.1%±23.6% of the calculated amount of the second 24 h rehydration formula.(3)There was no significant difference in the average total fluid replacement,average crystalline colloid volume,average sugar and water volume,urine volume,hemoglobin,hematocrit,and albumin content in children with different delayed resuscitation times(P> 0.05).There were significant differences in the average total fluid replacement,average crystal volume,and urine volume of children of different ages(P <0.05).There was a significant difference between the rehydration volume and curative effect of children with different burn areas(P <0.05).Comparison of test results: Blood routine examination: Comparison of hematocrit(HCT),after rehydration was significantly lower than before rehydration,t = 5.034,the difference was statistically significant(P <0.01);compared with hemoglobin content(HBG),significantly lower after rehydration Before rehydration,t = 5.830,the difference was statistically significant(P <0.01);compared with white blood cell count(WBC),it was significantly lower than that before rehydration,t=8.697,the difference was statistically significant(P <0.01);Conclusion Delayed resuscitation treatment for severe burn shock in children should be based on the traditional fluid replacement formula,taking into account the age of the child,delayed resuscitation fluid replacement time,burn area,burn depth,and many other factors,adopting an "individualized" comprehensive fluid replacement treatment plan,to smooth the shock as soon as possible In the future,based on the application of conventional shock monitoring indicators,invasive hemodynamics and abdominal pressure monitoring are used to improve the success rate of delayed recovery from severe burn shock.