Authors : Jing Li, Lihua Zhao, Jing Gao and Lirong Ran
Abstract: This study aims to conduct a preliminary exploration on the application value and prognosis of the insulin therapy in the burn shock resuscitation by observing the impact of insulin on the shock resuscitation fluid requirement, urine output and organ function of patients with major burns during the shock stage. Fifty eight patients with major burns including 31 males and 27 females admitted to the Burn Department of the hospital during the period from February, 2012 to December, 2012 were randomly arranged in an insulin treatment group and a control group, each consisting of 29 patients. The initial resuscitation fluid replacement was calculated based on the Ruijin formula, i.e., the total volumes of the colloid (plasma) and crystal (lactated Ringer’s solution) were calculated on a 1.5 mL/kg/1% TBSA basis and the ratio of crystal to colloid was between 1:1 and 2:1. The shock resuscitation indicators and platelet changes were tested. The unit colloid volume of the treatment group in the first 24 h was 0.98±0.29 mL/kg/1% TBSA which was significantly lower than (1.16±0.32) mL/kg/1% TBSA in the control group. Meanwhile, the unit urine outputs during the shock stage for the treatment group and the control group were 1.90±0.68 and 1.37±0.61 mL/kg/h, respectively. The treatment group showed significantly higher unit urine output than the control group. The differences between the two groups were statistically significant (p<0.05). The TBIL, DBIL, BUN and Cr levels between the patients in the two groups had no significant difference one day after burn. Since day 2 after burn, the treatment group showed lower levels of these indicators than the control group at various time points and the difference had statistical significance (p<0.05) at most time points. Platelet counting of the control group was higher than the treatment group on day 3, 6, 9 and 12. The platelet counting between the two groups showed statistical significance (p<0.05). The APACHE II score of the control group (6.49±2.18) was significantly lower than that of the treatment group (16.25±3.81) in the first 24 h after the admission. The APACHE II scores of the two groups had statistical significance (p<0.05). The application of insulin during the shock stage can reduce the colloid/crystal fluid requirement for resuscitation and increase the urine output of the patient with major burns. This therapy can also extenuate tissue damage and protect organ function. The study shows potential promise of the application of insulin in the shock resuscitation from severe burns.
Jing Li, Lihua Zhao, Jing Gao and Lirong Ran, 2014. Dynamic Changes of Biochemical Indices and Prognosis of Insulin Therapy in Burn Shock Resuscitation. Journal of Animal and Veterinary Advances, 13: 815-820.