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目的:回顾总结救治1例合并休克期呼吸心跳骤停的大面积烧伤的成功救治经验。方法:对1例火焰烧伤总面积96%TBSA(深Ⅱ度4%;Ⅲ、Ⅳ度92%)合并吸入性损伤、休克期(伤后27h)呼吸心跳骤停的患者,早期重要治疗包括合理的补液治疗,早期气管切开,心肺复苏治疗;早期切痂手术,自体微粒皮、异体大张皮覆盖创面;此外,营养支持、抗感染治疗也贯穿了治疗整个过程。结果:患者在休克期出现呼吸心跳骤停,经过及时、成功的心肺复苏治疗,在密切监测生命指标的前提下,采取早期分二次切痂自体微粒皮、异体大张皮移植;由于自体皮源的缺乏,后期分11次手术自体皮移植封闭创面,经过128天创面愈合,治愈出院。结论:对于休克期出现呼吸心跳骤停的大面积深度烧伤的患者,个体化的补液治疗、及时有效地心肺复苏是救治成功的前提;在心肺复苏之后,选择合适的手术时机,重视围手术期的治疗,早期切痂手术,自体微粒皮、异体大张皮覆盖创面仍然是可行的,并且对稳定病情,减少并发症非常重要。同时,积极营养治疗并且尽早向肠内营养过度,防治感染,及时有效利用有限的自体皮源封闭创面同样必不可少。
OBJECTIVE: To review and summarize the successful treatment of one case of extensive burn with respiratory arrest in shock stage. Methods: One case of burn injury with a total area of 96% TBSA (deep Ⅱ degree 4%; Ⅲ, Ⅳ degree 92%) with inhalation injury and shock resuscitation (shock 27h after resuscitation) patients with early resuscitation should include reasonable Rehydration therapy, early tracheotomy, cardiopulmonary resuscitation; early escharectomy, autologous particulate skin, allogeneic skin cover wounds; In addition, nutritional support, anti-infective treatment also runs through the entire process of treatment. Results: During the shock period, the patient had a sudden cardiac arrest. After timely and successful cardiopulmonary resuscitation, under the premise of closely monitoring vital signs, autograft and allogeneic macular skin grafting were performed in early stage. The lack of sources, the latter part of the sub-11 autologous skin grafts closed wounds, after 128 days wound healing, cured. CONCLUSIONS: Individualized rehydration therapy and timely and effective cardiopulmonary resuscitation are the prerequisites for successful treatment in patients with extensive deep burn with respiratory arrest in shock stage. After CPR, the appropriate timing of surgery is selected and the perioperative period is emphasized Of the treatment, early escharectomy, autologous skin, allogeneic skin cover wound is still feasible and stable disease, reduce complications is very important. At the same time, active nutrition treatment and as early as possible to the enteral nutrition, prevention and treatment of infection, timely and effective use of limited autologous skin source wound closure is also essential.