With the rapid development of science and technology, medical technology is also making continuous development and breakthroughs. In the 1980s, the burn wet exposure therapy was created to create a physiological wet environment of burn wounds, liquefy and eliminate burn necrotic tissues without damage, activate the potential regenerative cells into stem cells, provide regenerative substances and nutrients needed for the proliferation and division of stem cells, and finally realize physiological regeneration and repair of burn trauma wounds by connecting newborn tissues and cells with stem cells. After more than ten years of research and practice, the technology has been continuously developed, improved and perfected, and has had a great impact on the domestic and international level. With the deepening of the research, not only the in situ regeneration of skin organs on burn wounds, but also the in situ regeneration of other multi-tissue organs (broken finger regeneration), wound ulcer diseases, and the treatment of malignant tumors have also made promising research progress. Our hospital has also carried out some explorations in the treatment of large-area burns for the reference of our colleagues. Now the comprehensive treatment experience of our hospital in treating large-area burns is summarized as follows: I. Anti-shock treatment of burns anti-shock treatment is not only to replenish blood volume, but more importantly, to protect and restore the function and substance of organs, without the latter can’t be called as anti-shock treatment, and the principle treatments are as follows: (1) Strengthening the heart and protecting the function of the heart: a large amount of degradation of protein substances produced by some injured skin after the burn is absorbed, inhibiting and injuring the contraction of the heart. absorbed, inhibiting and injuring the contractile function of the heart and inducing cardiogenic shock. Where the total burn area is more than 50% (Ⅲ degree burns more than 10%) of the burn patient, after admission or post-injury routinely given 0.2 mg cediran (Lanatoside C) + 25% ~ 50% GS50ml intravenous injection, once a day. Similar cardiotonic agents, especially the newer fast-excreting cardiotonic agents, may also be used. After routine application, the dosage and number of times per day of cediran will be increased or decreased according to the number of heart rate increases and changes in peripheral circulation in the extremities. cediran can be discontinued if there is no abnormal change in cardiac function after 48 h. If there is no abnormal change in cardiac function after 48 h, cediran can be discontinued. If there is still abnormal cardiac function after 48h, it should be used routinely until the cardiac symptoms disappear. If the symptoms of heart failure appear in the whole course of burns treatment, temporary one-time intravenous injection of 0.2-0.4mg of cediran can be used. (2) Prevention and protection of renal function: after medium or large burns, the spasmodic contraction of renal parenchymal microvessels firstly leads to insufficient blood supply to the kidney, which causes dysfunction or obstacle, and it is the main pathogenesis in the period of shock, and it is also the main pathogenesis of renal failure. For this reason, early relief of renal parenchymal microvascular spasm is the key to antishock treatment and comprehensive medical treatment. The principle treatment is as follows: after medium or large area burn or after admission to the hospital, immediate intravenous drip 1% procaine 100 ml + 25% GS 100-200 ml + sodium benzoate caffeine 0.5 g + vitamin C1.0 g. Routine drip once a day. If the symptoms of shock are obvious or urine output is significantly reduced, it can be increased by 1 or 2 times, and patients with severe anuria can be titrated continuously until urination. This routine regimen may be continued until wound closure. (3) Supplementation of blood volume: after medium and large burns, intravascular fluid gradually leaks out to the inter-tissue and extra-traumatic area, resulting in a decrease in effective blood circulation and hypovolemic shock, so after the above treatment, then attention should be paid to timely supplementation of blood volume and protection of the effective blood circulation volume at the same time. What is emphasized here is to maintain the effective blood circulation volume, instead of mechanically and blindly inputting large amount of fluids without considering the body’s excretion and cardiac and renal function conditions, the principle treatment is as follows: Component requirements of rehydration fluid: 1 portion of crystalloid fluid (saline or 5% GNS), 1 portion of colloid fluid (1/2 plasma + 1/2 plasma substitute). The ratio of colloid and crystalloid components is 1:1. Requirements of rehydration volume: it should be based on the basic principles of surgery, how much is missing to make up for how much, but the burn patient is not as easy to calculate as the general surgical patients, so clinically grasp the following principles: daily requirement in the shock period = physiological requirement (ml) +1% area *1ml*kg (body weight) kg ( body weight) ml/h ( urine) infusion rate requirements: due to the heart and kidney and brain tissue burned by the post-injury heart Because the heart, kidney and brain tissue are stimulated by the burn trauma, in the first 24h rehydration, the speed of the first 12h should not be too fast, and should make up 1/2 or 3/5 of the total amount of the day, and the speed of the second 12h can be appropriately accelerated according to the heart’s ability and the recovery of renal function, and input 1/2 of the total amount of the day. 2 24h can be equalized. The third 24h should be strictly according to the urine volume and shock symptoms to determine the amount and speed. If the symptoms of shock improve significantly or no shock occurs, and the urine output is normal [about 1ml/h/.kg (body weight)], the volume of infusion can be reduced by 1/3 and the speed of infusion can be slowed down. (4) Nursing treatment during the shock period The occurrence of shock has an important relationship with the appropriateness of post-injury care in addition to thermal injury. Because of the post-injury organs are in a traumatic stress state, the body can hardly withstand any external blows. Therefore, shock period care should be an important step in the treatment. The principle treatment is as follows: ① burn wound immediately apply MEBO externally, isolate the wound from air contact, relieve pain, reduce and stop all traumatic external stimuli on the body, prohibit debridement. ② Keep the room at a constant temperature of 30 to 32 ℃. Never make the indoor temperature suddenly high and low. No indoor heat preservation conditions, then take the bedspread frame heat preservation. ③Pave the mattress and the dressing that touches the wound surface of the pressurized part. Gently change the dressing and MEBO under the wound surface of the pressure area every 12 h. Keep the patient in supine position. Keep the patient in supine position. ④Control the speed of infusion, prohibit fast and slow. Second, anti-infection treatment of post-burn infection, we believe that there are two main types: one is the natural onset of post-burn; the other is the post-burn secondary type. The natural onset type is similar to, but different from, the primary infections reported in surgical treatment of burns. The difference is that the natural-onset type includes symptoms of infection and indicators of infection that have not yet developed, i.e., the possibility of burn infection as a natural-onset response to burn injury. The secondary type is similar in concept to the surgical treatment of burns and includes all burn infections caused by exogenous sources and factors of infection. (1) The principle program of anti-infective treatment: ① The principle program of conventional treatment: according to the requirements of MEBT/MEBO, all burn patients with 10%) of the total area of burns need to be treated with conventional anti-infective treatment. Conventional anti-infective treatment refers to the systematic anti-infective treatment regardless of the presence or absence of infection after the burn. The principle program is: immediately after the injury intramuscular injection or intravenous drip one or more broad-spectrum efficient antibiotics, the larger the area, the deeper the depth of trauma, the application of antibiotics more broad-spectrum and strong. Antibiotics are applied up to day 5 for large deep II degree burns and up to day 7 or up to day 10 for large III degree burns. After the above application time, regardless of the condition should be immediately discontinued all antibiotics, that is, to complete the routine treatment. ② Symptomatic treatment principle program:Symptomatic anti-infective treatment, mainly refers to the prevention and anti-infective treatment of secondary infections and after conventional treatment. Symptomatic anti-infection treatment must emphasize clear secondary factors and meet the indications of infection diagnosis. The treatment program is implemented after the exclusion of secondary factors. The diagnosis of infection is critical in the pathogenesis of burns. Because the onset of burns is a mixture of inflammation and infection, the diagnosis of infection cannot be made because the patient is found to have fever, increased heart rate and other symptoms, and therefore cannot blindly carry out antibiotic systemic therapy. Because after the anti-infective conventional treatment period, it is the post-burn organ function recovery and wound repair period and reaction period, the body needs to take this opportunity to adjust themselves (body organs need protein synthesis and metabolism), adapted to the further onset of burns, so we should try to avoid the blind use of antibiotics and disturb the body’s disease-resistant program and function. Indications for symptomatic anti-infective therapy are: body temperature above 39.5°C or below 36°C, heart rate >140 beats/min, and blood leukocytes neutrophils found to have toxic granules. These three basic conditions must be present at the same time. If only leukocytes neutrophils appear poisoning particles, should be closely and timely observation, once the phenomenon of progress, can also be regarded as anti-infective treatment indications. (2) Symptomatic anti-infective treatment: Apply one or more antibiotics with strong and broad-spectrum antimicrobial effects that are not harmful to the kidneys. After the one-time application, observe the presence of toxic particles in leukocytes; if they disappear or decrease significantly, then stop the antibiotic after one additional application, and then continue to observe the toxic particles in neutrophils. If disappeared, then stop antibiotics immediately, if not disappeared, then should be detailed search and exclude the factors of secondary infection, or change antibiotics. If the patient’s symptoms and toxic granules in neutrophils do not improve or even tend to aggravate after a one-time application of antibiotics, a detailed search for secondary infections should be carried out immediately, which proves the existence of foci of infections, especially in the deep tissues of trauma or non-trauma tissues and venous or arterial injection puncture sites. A second treatment is then added and is usually effective. Common reasons for ineffectiveness are the presence of foci of infection under the trauma and secondary infection within the system. If the patient is weak, this should be accompanied by the administration of fresh blood to rebalance the internal environment. Neither should antibiotics be abused without indications of infection. Third, the balance of the liquefaction period of the trauma regulating the treatment of shock period, the burn wound into the rejection period. Generally deep Ⅱ degree burns in the fifth day after injury, the necrotic and damaged skin tissue and the depth of the undamaged and non-necrotic tissue rejection reaction, this reaction continues until the trauma necrotic tissue all excluded. During this period, due to the rejection reaction of the trauma, a variety of effects on the body, especially after the shock period, the body’s multi-system organs are in a state of trauma correction, its own function is low, and even has been subjected to burns in the early stage of severe trauma to produce a single-organ or multi-organ functional insufficiency. Therefore, the treatment during this period is the most complex, difficult and longest critical stage in the burn treatment program. After years of therapeutic practice, we believe that the core of the treatment during this period is to establish the comprehensive balance of the body’s ability, otherwise any single treatment will be difficult to succeed, which is called balance adjustment treatment. The treatment plan is as follows: (1) Remove the liquefied material from the wound in time: in the liquefaction stage of burn wound, the necrotic skin is liquefied from the surface to the inside layer by layer under the action of MEBO, and the timely removal of liquefied material is the key to the success of the treatment. However, there is a principle difference between removing liquefied material and surgical debridement. That is to say, after the patient receives the treatment, the doctor or nurse observes the changes of the wound at any time, if it is found that the MEBO on the wound has been completely changed into white liquefied material, then it should be dabbed gently with sterile dressing immediately, if it is found that in the process of liquefaction, the necrotic skin is liquefied into lumps and separated, and it cannot be completely liquefied, then it should be gently cut off the necrotic lumps of skin with surgical scissors, and then it should be gently dabbed with clean liquid. It is absolutely forbidden to cause any harm or irritation to the wound, which means that when removing the liquefied material, the patient should feel comfortable, and the child not only does not cry, but also likes to be cleaned by the doctor. In order to ensure the correct implementation of this treatment program, the clinic has made six provisions, namely, the requirement of removing liquefied material in the trauma to achieve: trauma without pain, no bleeding, no liquefied material, no interruption of MEBO, no dry scabs, and no impregnation. (2) Fluid balance treatment: after extensive burns, body fluids in addition to a large number of exudate from the trauma, but also at the same time, a large number of evaporation from the trauma, the body in order to cope with trauma and traumatic reactions, but also need to participate in the metabolism of body fluids, so to maintain the fluid balance of the body is one of the important steps in the treatment of the integrated. Balance of body fluids treatment, the following principles should be mastered: burns more than 30% of the total area of the patient should first be according to the amount of two times the physiological needs of the basic daily infusion volume. According to the signs and changes in urine output in a timely and symptomatic increase or decrease in the amount of fluid input (except for oral fluids, oral fluids and daily in and out of the amount of calculation), not too much or too little infusion, generally in the amplitude of the increase or decrease is not greater than 10% of the total amount. The composition of the fluids and the regulation of the acid-base balance of water and electrolytes are the same as the basic principles of surgical treatment. The total amount of fluids entered during this period of nutritional support therapy is also included. It should be noted that, after the input of fluids, the total amount and quality of urine should be closely observed (urine volume is maintained at 1-2 ml/h/kg body weight), and timely symptomatic treatment. 3) Body temperature balance regulation: The rejection reaction is strong during the period of trauma liquefaction, thus the body’s basal metabolism is significantly increased to adapt to the reaction needs of trauma. At the same time, in order to ensure the energy supply of the body, the body itself is in the state of catabolism. At this moment, due to the body to lose the skin in the thermoregulatory center of the feedback regulation, so that the body temperature balance dysregulation, the patient often appear high fever. The principle of clinical treatment is: firstly, the diagnosis of elevated body temperature should be clarified, and secondly, symptomatic and causative treatment should be provided, and it should never be misjudged as infection by elevated body temperature. Diagnostic indicators of temperature homeostasis dysregulation are: body temperature is higher than 39.5 ℃; daily temperature fluctuates, no regularity, does not have the indicators of infection; the patient’s symptoms are not directly proportional to the elevated temperature, that is, although the body temperature is high, but the patient feels like “normal”, the patient’s traumatic manifestations of normal. The treatment means should take physical cooling method. At the same time, timely cleaning of traumatic liquefaction, immediate effect. If in the summer high temperature climate, should be taken wound blowing method of cooling. If the effect of physical cooling is not obvious, especially in children’s burns, a small amount of hormone treatment can be considered, but at the same time pay attention to the prevention of peptic ulcer bleeding. If the effect of hormone treatment is still not obvious, anti-inflammatory or anti-infection treatment should be considered. (4) Heart rate, respiration, body temperature triad syndrome: large area burns in the process of clinical treatment of trauma liquefaction period, it is more likely to appear heart rate increased to > 120 times / min, body temperature is higher than 39.5 ℃, respiration is fast to > 30 times / min, the patient performance of shortness of breath, trance, obvious hypoxia, trauma darkened or browned, similar to the manifestation of sepsis, the disease progression is obvious, the symptom is known as heart rate, respiration, body temperature triad syndrome. This symptom is called heart rate, respiration, and temperature triad syndrome. The appearance of this syndrome is mostly caused by the patient’s mental stress, fatigue or sleep ferry insufficient, the onset of the disease is characterized by: a clear history of the onset of the disease, before the onset of the disease is relatively stable. Its pathogenesis is initially thought to be due to mental fatigue and severe sleep deprivation, resulting in heart failure response to cardiac exertion. The principle of its treatment was immediate cardiotonic therapy with immediate disappearance of symptoms. The method is as follows: Cediran 0.2～0.4mg+25%～50% glucose solution 50～100ml intravenous slow push (or similar cardiotonic drugs). If the therapeutic effect is not obvious, then consider the combined presence of infection, not immediately according to the treatment of fulminant sepsis. Clinically, many of these patients are misdiagnosed as sepsis, and as a result, after a large number of infusions and antibiotic treatment, the opportunity to save the heart is lost, and the patient dies, and finally the diagnosis is sepsis death. (5) Protective treatment of multiple organs: Entering the period of trauma liquefaction, the heart, kidney, liver, brain and digestive organs of the organism are in the post-traumatic correction state, with low function, and the organs themselves need physiological repair, and any method of increasing the burden on the organ function at this stage is another blow to the organism’s injury, and it is necessary to create a multi-organ recuperative environment to facilitate the transition of the multiple organs of the organism to physiological It is necessary to create an environment for multi-organ recuperation to facilitate the transition of multiple organs to physiologic recovery, and to establish the ability to resist disease for a longer period of time after the shock period. The method of creating this environment is to carry out protective treatment of multi-organ function, the specific methods are: ① check the consequences of each treatment program during the shock period, and understand the impact of each treatment program on the future function of the organs; ② stop using all the drugs that damage or adversely affect the heart, kidneys, liver, and digestive organs; ③ stop or prohibit the use of drugs that are not conducive to protein synthesis; ④ ensure the supply of calories to reduce or prevent catabolism; ⑤ increase the number of temporary drugs to prevent catabolism; and ⑤ increase the number of temporary drugs that are not beneficial to the organism. prevent catabolism; ⑤ increase the temporary use of drugs to protect liver, kidney and digestive tract, and use drugs to eliminate oxygen free radicals. Nutritional support therapy for extensive burns must be continued since the shock period until the patient recovers, and the principle of nutritional support therapy for MEBT/MEBO is basically the same as that for trauma surgery, but the difference is that the total energy and protein supply should be significantly larger than that for trauma surgery patients, and the time of nutritional support therapy is also longer. Clinically, in the 4th to 8th day after the injury, the supply of energy should be emphasized. After the 8th day until the end of the liquefaction period of the trauma, energy and protein are supplied in a balanced manner. When the wound enters the repair phase, it is changed to a protein supply. We advocate that after the burn shock period, immediately eat, as far as possible from the digestive tract to supply protein and energy. The principle is as follows: daily caloric requirement of burn patients (joule) = (24 × kg body weight + 40 × % of burned area) × 6.8 supply of protein to caloric ratio of 1:150~200. Caloric distribution: 60% of sugar, 30% of fat, 10% of protein. On the basis of ensuring the above total caloric energy and protein supply, burn patients from the digestive tract into high-protein foods and vegetables. Fifth, symptomatic treatment in general, a large area of burns treatment, not simply on the local wound healing and manifestation of local and systemic symptoms and etiology of the treatment, but involves internal medicine, surgery, endocrine, psychological and other multidisciplinary aspects of the integrated treatment. In terms of comprehensive symptomatic treatment, there is no specific fixed pattern or program in the clinic, but requires doctors to strictly observe the condition, analyze the condition and formulate a practical medical plan with the analysis method of general medicine.