• 严重烧伤后应用血液稀释疗法临床意义的探讨
  • The clinical significance of the application of blood dilution therapy post severe burn
    刘军  徐刚 
     
    严重烧伤后大量体液外渗造成循环血容量不足而导致休克,此时血液浓缩明显,红细胞压积(Hct)升高显著.血液稀释疗法是通过降低Hct和血黏度而达到其治疗目的,其作为一种治疗手段应用于临床已有数十年历史,而在严重烧伤治疗中的应用,国内外尚未见报道.因此,将血液稀释疗法应用于严重烧伤的临床治疗以提高其临床治愈率是值得探讨的课题.现将血液稀释疗法的发展及临床应用综述如下,以探讨严重烧伤后应用血液稀释疗法的临床意义.……
     
    作者简介:刘军(1969~),女(汉族),唐山人,1993年河北医科大学毕业,2003年河北医科大学硕士,现从事烧伤休克和临床康复研究,主治医师.徐刚(1965~),男(汉族),唐山人,1988年河北医科大学毕业,1996年河北医科大学硕士,外科主任,主任医师.
    作者单位:刘军(唐山工人医院烧伤整形外科,河北,唐山,063000) 
         徐刚(唐山工人医院烧伤整形外科,河北,唐山,063000) 
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